|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$11,064.69
|
|
|
Service Code
|
APR-DRG 9303
|
| Min. Negotiated Rate |
$10,537.80 |
| Max. Negotiated Rate |
$11,064.69 |
| Rate for Payer: BCBS Complete |
$11,064.69
|
| Rate for Payer: Mclaren Medicaid |
$10,537.80
|
| Rate for Payer: Meridian Medicaid |
$11,064.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,537.80
|
| Rate for Payer: UHC Medicaid |
$10,537.80
|
| Rate for Payer: UHCCP Medicaid |
$10,537.80
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$301.60
|
|
|
Service Code
|
NDC 40985022368
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.53 |
| Max. Negotiated Rate |
$271.44 |
| Rate for Payer: Aetna Commercial |
$256.36
|
| Rate for Payer: Aetna Medicare |
$150.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.04
|
| Rate for Payer: BCBS Complete |
$120.64
|
| Rate for Payer: Cash Price |
$241.28
|
| Rate for Payer: Cofinity Advantage |
$211.12
|
| Rate for Payer: Cofinity Commercial |
$259.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.28
|
| Rate for Payer: Healthscope Commercial |
$271.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.20
|
| Rate for Payer: PHP Commercial |
$256.36
|
| Rate for Payer: Priority Health SBD |
$190.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.04
|
| Rate for Payer: UHC Core |
$157.13
|
| Rate for Payer: UHC Exchange |
$118.53
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$187.20
|
|
|
Service Code
|
NDC 80681016000
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.94 |
| Max. Negotiated Rate |
$168.48 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.68
|
| Rate for Payer: Cash Price |
$149.76
|
| Rate for Payer: Cofinity Advantage |
$131.04
|
| Rate for Payer: Cofinity Commercial |
$160.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.76
|
| Rate for Payer: Healthscope Commercial |
$168.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.40
|
| Rate for Payer: PHP Commercial |
$159.12
|
| Rate for Payer: Priority Health SBD |
$117.94
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$207.90
|
|
|
Service Code
|
NDC 77333086110
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.70 |
| Max. Negotiated Rate |
$187.11 |
| Rate for Payer: Aetna Commercial |
$176.72
|
| Rate for Payer: Aetna Medicare |
$103.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.13
|
| Rate for Payer: BCBS Complete |
$83.16
|
| Rate for Payer: Cash Price |
$166.32
|
| Rate for Payer: Cofinity Advantage |
$145.53
|
| Rate for Payer: Cofinity Commercial |
$178.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.32
|
| Rate for Payer: Healthscope Commercial |
$187.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.93
|
| Rate for Payer: PHP Commercial |
$176.72
|
| Rate for Payer: Priority Health SBD |
$130.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.13
|
| Rate for Payer: UHC Core |
$108.32
|
| Rate for Payer: UHC Exchange |
$81.70
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$301.60
|
|
|
Service Code
|
NDC 40985022368
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.01 |
| Max. Negotiated Rate |
$271.44 |
| Rate for Payer: Aetna Commercial |
$256.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.04
|
| Rate for Payer: Cash Price |
$241.28
|
| Rate for Payer: Cofinity Advantage |
$211.12
|
| Rate for Payer: Cofinity Commercial |
$259.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.28
|
| Rate for Payer: Healthscope Commercial |
$271.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.20
|
| Rate for Payer: PHP Commercial |
$256.36
|
| Rate for Payer: Priority Health SBD |
$190.01
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$2.08
|
|
|
Service Code
|
NDC 77333086125
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna Medicare |
$1.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Advantage |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.56
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health SBD |
$1.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.35
|
| Rate for Payer: UHC Core |
$1.08
|
| Rate for Payer: UHC Exchange |
$0.82
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$207.90
|
|
|
Service Code
|
NDC 77333086110
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.98 |
| Max. Negotiated Rate |
$187.11 |
| Rate for Payer: Aetna Commercial |
$176.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.13
|
| Rate for Payer: Cash Price |
$166.32
|
| Rate for Payer: Cofinity Advantage |
$145.53
|
| Rate for Payer: Cofinity Commercial |
$178.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.32
|
| Rate for Payer: Healthscope Commercial |
$187.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.93
|
| Rate for Payer: PHP Commercial |
$176.72
|
| Rate for Payer: Priority Health SBD |
$130.98
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$2.08
|
|
|
Service Code
|
NDC 77333086125
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Advantage |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.56
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health SBD |
$1.31
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
NDC 00904549261
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Advantage |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health SBD |
$113.40
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
NDC 00904549261
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.74 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Medicare |
$90.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.00
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Advantage |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health SBD |
$113.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.00
|
| Rate for Payer: UHC Core |
$93.78
|
| Rate for Payer: UHC Exchange |
$70.74
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$187.20
|
|
|
Service Code
|
NDC 80681016000
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.57 |
| Max. Negotiated Rate |
$168.48 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna Medicare |
$93.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.68
|
| Rate for Payer: BCBS Complete |
$74.88
|
| Rate for Payer: Cash Price |
$149.76
|
| Rate for Payer: Cofinity Advantage |
$131.04
|
| Rate for Payer: Cofinity Commercial |
$160.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.76
|
| Rate for Payer: Healthscope Commercial |
$168.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.40
|
| Rate for Payer: PHP Commercial |
$159.12
|
| Rate for Payer: Priority Health SBD |
$117.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.68
|
| Rate for Payer: UHC Core |
$97.53
|
| Rate for Payer: UHC Exchange |
$73.57
|
|
|
MULTIVITAMIN-MINERALS-IRON FUMARATE 19 MG-FOLIC ACID 400 MCG TABLET
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
NDC 96295012782
|
| Hospital Charge Code |
196928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.74 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna Medicare |
$104.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.20
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Advantage |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.00
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health SBD |
$131.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.20
|
| Rate for Payer: UHC Core |
$108.37
|
| Rate for Payer: UHC Exchange |
$81.74
|
|
|
MULTIVITAMIN-MINERALS-IRON FUMARATE 19 MG-FOLIC ACID 400 MCG TABLET
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
NDC 96295012782
|
| Hospital Charge Code |
196928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.20
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Advantage |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.00
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health SBD |
$131.04
|
|
|
MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID
|
Facility
|
IP
|
$24.60
|
|
|
Service Code
|
NDC 00005434462
|
| Hospital Charge Code |
119617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$22.14 |
| Rate for Payer: Aetna Commercial |
$20.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.99
|
| Rate for Payer: Cash Price |
$19.68
|
| Rate for Payer: Cofinity Advantage |
$17.22
|
| Rate for Payer: Cofinity Commercial |
$21.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.68
|
| Rate for Payer: Healthscope Commercial |
$22.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.45
|
| Rate for Payer: PHP Commercial |
$20.91
|
| Rate for Payer: Priority Health SBD |
$15.50
|
|
|
MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID
|
Facility
|
OP
|
$24.60
|
|
|
Service Code
|
NDC 00005434462
|
| Hospital Charge Code |
119617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$22.14 |
| Rate for Payer: Aetna Commercial |
$20.91
|
| Rate for Payer: Aetna Medicare |
$12.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.99
|
| Rate for Payer: BCBS Complete |
$9.84
|
| Rate for Payer: Cash Price |
$19.68
|
| Rate for Payer: Cofinity Advantage |
$17.22
|
| Rate for Payer: Cofinity Commercial |
$21.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.68
|
| Rate for Payer: Healthscope Commercial |
$22.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.45
|
| Rate for Payer: PHP Commercial |
$20.91
|
| Rate for Payer: Priority Health SBD |
$15.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.99
|
| Rate for Payer: UHC Core |
$12.82
|
| Rate for Payer: UHC Exchange |
$9.67
|
|
|
MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID
|
Facility
|
IP
|
$21.95
|
|
|
Service Code
|
NDC 09900000800
|
| Hospital Charge Code |
119617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$19.75 |
| Rate for Payer: Aetna Commercial |
$18.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.27
|
| Rate for Payer: Cash Price |
$17.56
|
| Rate for Payer: Cofinity Advantage |
$15.37
|
| Rate for Payer: Cofinity Commercial |
$18.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.56
|
| Rate for Payer: Healthscope Commercial |
$19.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.46
|
| Rate for Payer: PHP Commercial |
$18.66
|
| Rate for Payer: Priority Health SBD |
$13.83
|
|
|
MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID
|
Facility
|
OP
|
$21.95
|
|
|
Service Code
|
NDC 09900000800
|
| Hospital Charge Code |
119617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$19.75 |
| Rate for Payer: Aetna Commercial |
$18.66
|
| Rate for Payer: Aetna Medicare |
$10.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.27
|
| Rate for Payer: BCBS Complete |
$8.78
|
| Rate for Payer: Cash Price |
$17.56
|
| Rate for Payer: Cofinity Advantage |
$15.37
|
| Rate for Payer: Cofinity Commercial |
$18.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.56
|
| Rate for Payer: Healthscope Commercial |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.46
|
| Rate for Payer: PHP Commercial |
$18.66
|
| Rate for Payer: Priority Health SBD |
$13.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.27
|
| Rate for Payer: UHC Core |
$11.44
|
| Rate for Payer: UHC Exchange |
$8.63
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$29.26
|
|
|
Service Code
|
NDC 45802011222
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.43 |
| Max. Negotiated Rate |
$26.33 |
| Rate for Payer: Aetna Commercial |
$24.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.02
|
| Rate for Payer: Cash Price |
$23.41
|
| Rate for Payer: Cofinity Advantage |
$20.48
|
| Rate for Payer: Cofinity Commercial |
$25.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.41
|
| Rate for Payer: Healthscope Commercial |
$26.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.95
|
| Rate for Payer: PHP Commercial |
$24.87
|
| Rate for Payer: Priority Health SBD |
$18.43
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$16.27
|
|
|
Service Code
|
NDC 51672131201
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.25 |
| Max. Negotiated Rate |
$14.64 |
| Rate for Payer: Aetna Commercial |
$13.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.58
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cofinity Advantage |
$11.39
|
| Rate for Payer: Cofinity Commercial |
$13.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.02
|
| Rate for Payer: Healthscope Commercial |
$14.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.20
|
| Rate for Payer: PHP Commercial |
$13.83
|
| Rate for Payer: Priority Health SBD |
$10.25
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$29.26
|
|
|
Service Code
|
NDC 45802011222
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$26.33 |
| Rate for Payer: Aetna Commercial |
$24.87
|
| Rate for Payer: Aetna Medicare |
$14.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.02
|
| Rate for Payer: BCBS Complete |
$11.70
|
| Rate for Payer: Cash Price |
$23.41
|
| Rate for Payer: Cofinity Advantage |
$20.48
|
| Rate for Payer: Cofinity Commercial |
$25.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.41
|
| Rate for Payer: Healthscope Commercial |
$26.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.95
|
| Rate for Payer: PHP Commercial |
$24.87
|
| Rate for Payer: Priority Health SBD |
$18.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.02
|
| Rate for Payer: UHC Core |
$15.24
|
| Rate for Payer: UHC Exchange |
$11.50
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$29.96
|
|
|
Service Code
|
NDC 68462018022
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Aetna Commercial |
$25.47
|
| Rate for Payer: Aetna Medicare |
$14.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: BCBS Complete |
$11.98
|
| Rate for Payer: Cash Price |
$23.97
|
| Rate for Payer: Cofinity Advantage |
$20.97
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.97
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.47
|
| Rate for Payer: PHP Commercial |
$25.47
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.47
|
| Rate for Payer: UHC Core |
$15.61
|
| Rate for Payer: UHC Exchange |
$11.77
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$20.79
|
|
|
Service Code
|
NDC 51672131200
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$18.71 |
| Rate for Payer: PHP Commercial |
$17.67
|
| Rate for Payer: Aetna Commercial |
$17.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.51
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cofinity Advantage |
$14.55
|
| Rate for Payer: Cofinity Commercial |
$17.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.63
|
| Rate for Payer: Healthscope Commercial |
$18.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.59
|
| Rate for Payer: Priority Health SBD |
$13.10
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$29.65
|
|
|
Service Code
|
NDC 00093101042
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Aetna Medicare |
$14.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.27
|
| Rate for Payer: BCBS Complete |
$11.86
|
| Rate for Payer: Cash Price |
$23.72
|
| Rate for Payer: Cofinity Advantage |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$25.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.72
|
| Rate for Payer: Healthscope Commercial |
$26.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.24
|
| Rate for Payer: PHP Commercial |
$25.20
|
| Rate for Payer: Priority Health SBD |
$18.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.27
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: UHC Exchange |
$11.65
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$20.79
|
|
|
Service Code
|
NDC 51672131200
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$18.71 |
| Rate for Payer: Aetna Commercial |
$17.67
|
| Rate for Payer: Aetna Medicare |
$10.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.51
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cofinity Advantage |
$14.55
|
| Rate for Payer: Cofinity Commercial |
$17.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.63
|
| Rate for Payer: Healthscope Commercial |
$18.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.59
|
| Rate for Payer: PHP Commercial |
$17.67
|
| Rate for Payer: Priority Health SBD |
$13.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.51
|
| Rate for Payer: UHC Core |
$10.83
|
| Rate for Payer: UHC Exchange |
$8.17
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$16.27
|
|
|
Service Code
|
NDC 51672131201
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$14.64 |
| Rate for Payer: Aetna Commercial |
$13.83
|
| Rate for Payer: Aetna Medicare |
$8.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.58
|
| Rate for Payer: BCBS Complete |
$6.51
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cofinity Advantage |
$11.39
|
| Rate for Payer: Cofinity Commercial |
$13.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.02
|
| Rate for Payer: Healthscope Commercial |
$14.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.20
|
| Rate for Payer: PHP Commercial |
$13.83
|
| Rate for Payer: Priority Health SBD |
$10.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.58
|
| Rate for Payer: UHC Core |
$8.48
|
| Rate for Payer: UHC Exchange |
$6.39
|
|
