|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$76,248.14
|
|
|
Service Code
|
MSDRG 826
|
| Min. Negotiated Rate |
$34,893.60 |
| Max. Negotiated Rate |
$76,248.14 |
| Rate for Payer: Aetna Medicare |
$38,199.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45,912.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45,912.62
|
| Rate for Payer: BCBS MAPPO |
$36,730.10
|
| Rate for Payer: BCBS Trust/PPO |
$55,924.05
|
| Rate for Payer: BCN Commercial |
$55,924.05
|
| Rate for Payer: BCN Medicare Advantage |
$36,730.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36,730.10
|
| Rate for Payer: Mclaren Medicare |
$36,730.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38,566.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42,239.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$40,403.11
|
| Rate for Payer: Nomi Health Commercial |
$60,343.62
|
| Rate for Payer: PACE Medicare |
$34,893.60
|
| Rate for Payer: PACE SWMI |
$36,730.10
|
| Rate for Payer: PHP Medicare Advantage |
$36,730.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$75,416.15
|
| Rate for Payer: Priority Health Medicare |
$36,730.10
|
| Rate for Payer: Priority Health Tiered Network |
$60,332.91
|
| Rate for Payer: Railroad Medicare Medicare |
$36,730.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76,248.14
|
| Rate for Payer: UHC Core |
$63,791.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$36,730.10
|
| Rate for Payer: UHC Exchange |
$52,096.66
|
| Rate for Payer: VA VA |
$36,730.10
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$38,047.36
|
|
|
Service Code
|
MSDRG 828
|
| Min. Negotiated Rate |
$13,059.05 |
| Max. Negotiated Rate |
$38,047.36 |
| Rate for Payer: Aetna Medicare |
$14,296.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,182.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,182.96
|
| Rate for Payer: BCBS MAPPO |
$13,746.37
|
| Rate for Payer: BCBS Trust/PPO |
$38,047.36
|
| Rate for Payer: BCN Commercial |
$38,047.36
|
| Rate for Payer: BCN Medicare Advantage |
$13,746.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,746.37
|
| Rate for Payer: Mclaren Medicare |
$13,746.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,433.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,808.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,121.01
|
| Rate for Payer: Nomi Health Commercial |
$21,979.02
|
| Rate for Payer: PACE Medicare |
$13,059.05
|
| Rate for Payer: PACE SWMI |
$13,746.37
|
| Rate for Payer: PHP Medicare Advantage |
$13,746.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27,468.90
|
| Rate for Payer: Priority Health Medicare |
$13,746.37
|
| Rate for Payer: Priority Health Tiered Network |
$21,975.12
|
| Rate for Payer: Railroad Medicare Medicare |
$13,746.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,771.94
|
| Rate for Payer: UHC Core |
$23,234.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,746.37
|
| Rate for Payer: UHC Exchange |
$18,975.22
|
| Rate for Payer: VA VA |
$13,746.37
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$75,998.75
|
|
|
Service Code
|
MSDRG 829
|
| Min. Negotiated Rate |
$23,750.18 |
| Max. Negotiated Rate |
$75,998.75 |
| Rate for Payer: Aetna Medicare |
$26,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,250.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,250.24
|
| Rate for Payer: BCBS MAPPO |
$25,000.19
|
| Rate for Payer: BCBS Trust/PPO |
$75,998.75
|
| Rate for Payer: BCN Commercial |
$75,998.75
|
| Rate for Payer: BCN Medicare Advantage |
$25,000.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,000.19
|
| Rate for Payer: Mclaren Medicare |
$25,000.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26,250.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,750.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$27,500.21
|
| Rate for Payer: Nomi Health Commercial |
$40,764.00
|
| Rate for Payer: PACE Medicare |
$23,750.18
|
| Rate for Payer: PACE SWMI |
$25,000.19
|
| Rate for Payer: PHP Medicare Advantage |
$25,000.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$50,945.96
|
| Rate for Payer: Priority Health Medicare |
$25,000.19
|
| Rate for Payer: Priority Health Tiered Network |
$40,756.76
|
| Rate for Payer: Railroad Medicare Medicare |
$25,000.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51,508.00
|
| Rate for Payer: UHC Core |
$43,092.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25,000.19
|
| Rate for Payer: UHC Exchange |
$35,192.92
|
| Rate for Payer: VA VA |
$25,000.19
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$24,531.50
|
|
|
Service Code
|
MSDRG 830
|
| Min. Negotiated Rate |
$11,599.48 |
| Max. Negotiated Rate |
$24,531.50 |
| Rate for Payer: Aetna Medicare |
$12,698.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,262.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,262.48
|
| Rate for Payer: BCBS MAPPO |
$12,209.98
|
| Rate for Payer: BCBS Trust/PPO |
$20,823.76
|
| Rate for Payer: BCN Commercial |
$20,823.76
|
| Rate for Payer: BCN Medicare Advantage |
$12,209.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,209.98
|
| Rate for Payer: Mclaren Medicare |
$12,209.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,820.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,041.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,430.98
|
| Rate for Payer: Nomi Health Commercial |
$19,414.50
|
| Rate for Payer: PACE Medicare |
$11,599.48
|
| Rate for Payer: PACE SWMI |
$12,209.98
|
| Rate for Payer: PHP Medicare Advantage |
$12,209.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,263.82
|
| Rate for Payer: Priority Health Medicare |
$12,209.98
|
| Rate for Payer: Priority Health Tiered Network |
$19,411.05
|
| Rate for Payer: Railroad Medicare Medicare |
$12,209.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,531.50
|
| Rate for Payer: UHC Core |
$20,523.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,209.98
|
| Rate for Payer: UHC Exchange |
$16,761.19
|
| Rate for Payer: VA VA |
$12,209.98
|
|
|
MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 1 TO 4 INTRAMURAL MYOMA(S) WITH TOTAL WEIGHT OF 250 G OR LESS AND/OR REMOVAL OF SURFACE MYOMAS; VAGINAL APPROACH
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 58145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,576.91 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,576.91
|
| Rate for Payer: BCN Commercial |
$1,576.91
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
OP
|
$281.17
|
|
|
Service Code
|
NDC 60687030225
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$253.05 |
| Rate for Payer: Aetna Commercial |
$238.99
|
| Rate for Payer: Aetna Medicare |
$140.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.76
|
| Rate for Payer: BCBS Complete |
$112.47
|
| Rate for Payer: Cash Price |
$224.94
|
| Rate for Payer: Cofinity Advantage |
$196.82
|
| Rate for Payer: Cofinity Commercial |
$241.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.94
|
| Rate for Payer: Healthscope Commercial |
$253.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$224.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.88
|
| Rate for Payer: PHP Commercial |
$238.99
|
| Rate for Payer: Priority Health SBD |
$177.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.76
|
| Rate for Payer: UHC Core |
$146.49
|
| Rate for Payer: UHC Exchange |
$110.50
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
OP
|
$11.51
|
|
|
Service Code
|
NDC 51079081201
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$10.36 |
| Rate for Payer: Aetna Commercial |
$9.78
|
| Rate for Payer: Aetna Medicare |
$5.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.48
|
| Rate for Payer: BCBS Complete |
$4.60
|
| Rate for Payer: Cash Price |
$9.21
|
| Rate for Payer: Cofinity Advantage |
$8.06
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.21
|
| Rate for Payer: Healthscope Commercial |
$10.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.63
|
| Rate for Payer: PHP Commercial |
$9.78
|
| Rate for Payer: Priority Health SBD |
$7.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.48
|
| Rate for Payer: UHC Core |
$6.00
|
| Rate for Payer: UHC Exchange |
$4.52
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
IP
|
$9.38
|
|
|
Service Code
|
NDC 60687030295
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$8.44 |
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.10
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cofinity Advantage |
$6.57
|
| Rate for Payer: Cofinity Commercial |
$8.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.50
|
| Rate for Payer: Healthscope Commercial |
$8.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.04
|
| Rate for Payer: PHP Commercial |
$7.97
|
| Rate for Payer: Priority Health SBD |
$5.91
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
OP
|
$1,150.33
|
|
|
Service Code
|
NDC 51079081220
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$452.08 |
| Max. Negotiated Rate |
$1,035.30 |
| Rate for Payer: Aetna Commercial |
$977.78
|
| Rate for Payer: Aetna Medicare |
$575.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.71
|
| Rate for Payer: BCBS Complete |
$460.13
|
| Rate for Payer: Cash Price |
$920.26
|
| Rate for Payer: Cofinity Advantage |
$805.23
|
| Rate for Payer: Cofinity Commercial |
$989.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$920.26
|
| Rate for Payer: Healthscope Commercial |
$1,035.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$920.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$977.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$862.75
|
| Rate for Payer: PHP Commercial |
$977.78
|
| Rate for Payer: Priority Health SBD |
$724.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$747.71
|
| Rate for Payer: UHC Core |
$599.32
|
| Rate for Payer: UHC Exchange |
$452.08
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
IP
|
$11.51
|
|
|
Service Code
|
NDC 51079081201
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$10.36 |
| Rate for Payer: Aetna Commercial |
$9.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.48
|
| Rate for Payer: Cash Price |
$9.21
|
| Rate for Payer: Cofinity Advantage |
$8.06
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.21
|
| Rate for Payer: Healthscope Commercial |
$10.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.63
|
| Rate for Payer: PHP Commercial |
$9.78
|
| Rate for Payer: Priority Health SBD |
$7.25
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
OP
|
$350.15
|
|
|
Service Code
|
NDC 69097086707
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.61 |
| Max. Negotiated Rate |
$315.13 |
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna Medicare |
$175.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.60
|
| Rate for Payer: BCBS Complete |
$140.06
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Advantage |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$280.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$262.61
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health SBD |
$220.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.60
|
| Rate for Payer: UHC Core |
$182.43
|
| Rate for Payer: UHC Exchange |
$137.61
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
OP
|
$687.84
|
|
|
Service Code
|
NDC 00378002801
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.32 |
| Max. Negotiated Rate |
$619.06 |
| Rate for Payer: Aetna Commercial |
$584.66
|
| Rate for Payer: Aetna Medicare |
$343.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.10
|
| Rate for Payer: BCBS Complete |
$275.14
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cofinity Advantage |
$481.49
|
| Rate for Payer: Cofinity Commercial |
$591.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.27
|
| Rate for Payer: Healthscope Commercial |
$619.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$550.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.88
|
| Rate for Payer: PHP Commercial |
$584.66
|
| Rate for Payer: Priority Health SBD |
$433.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$447.10
|
| Rate for Payer: UHC Core |
$358.36
|
| Rate for Payer: UHC Exchange |
$270.32
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
IP
|
$255.64
|
|
|
Service Code
|
NDC 00904707007
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.05 |
| Max. Negotiated Rate |
$230.08 |
| Rate for Payer: Aetna Commercial |
$217.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.17
|
| Rate for Payer: Cash Price |
$204.51
|
| Rate for Payer: Cofinity Advantage |
$178.95
|
| Rate for Payer: Cofinity Commercial |
$219.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.51
|
| Rate for Payer: Healthscope Commercial |
$230.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.73
|
| Rate for Payer: PHP Commercial |
$217.29
|
| Rate for Payer: Priority Health SBD |
$161.05
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
IP
|
$1,100.01
|
|
|
Service Code
|
NDC 00904707061
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$693.01 |
| Max. Negotiated Rate |
$990.01 |
| Rate for Payer: Aetna Commercial |
$935.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$715.01
|
| Rate for Payer: Cash Price |
$880.01
|
| Rate for Payer: Cofinity Advantage |
$770.01
|
| Rate for Payer: Cofinity Commercial |
$946.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$880.01
|
| Rate for Payer: Healthscope Commercial |
$990.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$935.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$825.01
|
| Rate for Payer: PHP Commercial |
$935.01
|
| Rate for Payer: Priority Health SBD |
$693.01
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
OP
|
$255.64
|
|
|
Service Code
|
NDC 00904707007
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.47 |
| Max. Negotiated Rate |
$230.08 |
| Rate for Payer: Aetna Commercial |
$217.29
|
| Rate for Payer: Aetna Medicare |
$127.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.17
|
| Rate for Payer: BCBS Complete |
$102.26
|
| Rate for Payer: Cash Price |
$204.51
|
| Rate for Payer: Cofinity Advantage |
$178.95
|
| Rate for Payer: Cofinity Commercial |
$219.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.51
|
| Rate for Payer: Healthscope Commercial |
$230.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.73
|
| Rate for Payer: PHP Commercial |
$217.29
|
| Rate for Payer: Priority Health SBD |
$161.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.17
|
| Rate for Payer: UHC Core |
$133.19
|
| Rate for Payer: UHC Exchange |
$100.47
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
IP
|
$687.84
|
|
|
Service Code
|
NDC 00378002801
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$433.34 |
| Max. Negotiated Rate |
$619.06 |
| Rate for Payer: Aetna Commercial |
$584.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.10
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cofinity Advantage |
$481.49
|
| Rate for Payer: Cofinity Commercial |
$591.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.27
|
| Rate for Payer: Healthscope Commercial |
$619.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.88
|
| Rate for Payer: PHP Commercial |
$584.66
|
| Rate for Payer: Priority Health SBD |
$433.34
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
IP
|
$350.15
|
|
|
Service Code
|
NDC 69097086707
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.59 |
| Max. Negotiated Rate |
$315.13 |
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.60
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Advantage |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$262.61
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health SBD |
$220.59
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
OP
|
$1,100.01
|
|
|
Service Code
|
NDC 00904707061
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$432.30 |
| Max. Negotiated Rate |
$990.01 |
| Rate for Payer: Aetna Commercial |
$935.01
|
| Rate for Payer: Aetna Medicare |
$550.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$715.01
|
| Rate for Payer: BCBS Complete |
$440.00
|
| Rate for Payer: Cash Price |
$880.01
|
| Rate for Payer: Cofinity Advantage |
$770.01
|
| Rate for Payer: Cofinity Commercial |
$946.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$880.01
|
| Rate for Payer: Healthscope Commercial |
$990.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$880.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$935.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$825.01
|
| Rate for Payer: PHP Commercial |
$935.01
|
| Rate for Payer: Priority Health SBD |
$693.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$715.01
|
| Rate for Payer: UHC Core |
$573.11
|
| Rate for Payer: UHC Exchange |
$432.30
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
IP
|
$281.17
|
|
|
Service Code
|
NDC 60687030225
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.14 |
| Max. Negotiated Rate |
$253.05 |
| Rate for Payer: Aetna Commercial |
$238.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.76
|
| Rate for Payer: Cash Price |
$224.94
|
| Rate for Payer: Cofinity Advantage |
$196.82
|
| Rate for Payer: Cofinity Commercial |
$241.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.94
|
| Rate for Payer: Healthscope Commercial |
$253.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.88
|
| Rate for Payer: PHP Commercial |
$238.99
|
| Rate for Payer: Priority Health SBD |
$177.14
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
OP
|
$9.38
|
|
|
Service Code
|
NDC 60687030295
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$8.44 |
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: Aetna Medicare |
$4.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.10
|
| Rate for Payer: BCBS Complete |
$3.75
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cofinity Advantage |
$6.57
|
| Rate for Payer: Cofinity Commercial |
$8.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.50
|
| Rate for Payer: Healthscope Commercial |
$8.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.04
|
| Rate for Payer: PHP Commercial |
$7.97
|
| Rate for Payer: Priority Health SBD |
$5.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.10
|
| Rate for Payer: UHC Core |
$4.89
|
| Rate for Payer: UHC Exchange |
$3.69
|
|
|
NADOLOL 20 MG TABLET
|
Facility
|
IP
|
$1,150.33
|
|
|
Service Code
|
NDC 51079081220
|
| Hospital Charge Code |
5330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$724.71 |
| Max. Negotiated Rate |
$1,035.30 |
| Rate for Payer: Aetna Commercial |
$977.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.71
|
| Rate for Payer: Cash Price |
$920.26
|
| Rate for Payer: Cofinity Advantage |
$805.23
|
| Rate for Payer: Cofinity Commercial |
$989.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$920.26
|
| Rate for Payer: Healthscope Commercial |
$1,035.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$977.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$862.75
|
| Rate for Payer: PHP Commercial |
$977.78
|
| Rate for Payer: Priority Health SBD |
$724.71
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$147.74
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna Commercial |
$125.58
|
| Rate for Payer: Aetna Commercial |
$119.42
|
| Rate for Payer: Aetna Medicare |
$70.25
|
| Rate for Payer: Aetna Medicare |
$73.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.32
|
| Rate for Payer: BCBS Complete |
$56.20
|
| Rate for Payer: BCBS Complete |
$59.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$118.19
|
| Rate for Payer: Cash Price |
$112.39
|
| Rate for Payer: Cash Price |
$118.19
|
| Rate for Payer: Cash Price |
$112.39
|
| Rate for Payer: Cofinity Advantage |
$103.42
|
| Rate for Payer: Cofinity Advantage |
$98.34
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Cofinity Commercial |
$120.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.19
|
| Rate for Payer: Healthscope Commercial |
$126.44
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.37
|
| Rate for Payer: PHP Commercial |
$125.58
|
| Rate for Payer: PHP Commercial |
$119.42
|
| Rate for Payer: Priority Health SBD |
$93.08
|
| Rate for Payer: Priority Health SBD |
$88.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$147.74
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.08 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna Commercial |
$125.58
|
| Rate for Payer: Aetna Commercial |
$119.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.03
|
| Rate for Payer: Cash Price |
$112.39
|
| Rate for Payer: Cash Price |
$118.19
|
| Rate for Payer: Cofinity Advantage |
$103.42
|
| Rate for Payer: Cofinity Advantage |
$98.34
|
| Rate for Payer: Cofinity Commercial |
$120.82
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.19
|
| Rate for Payer: Healthscope Commercial |
$126.44
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.37
|
| Rate for Payer: PHP Commercial |
$119.42
|
| Rate for Payer: PHP Commercial |
$125.58
|
| Rate for Payer: Priority Health SBD |
$88.51
|
| Rate for Payer: Priority Health SBD |
$93.08
|
|
|
NAFCILLIN 2 GRAM IVPB (INTRA-OP)
|
Facility
|
IP
|
$21.20
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
168911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Aetna Commercial |
$18.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.78
|
| Rate for Payer: Cash Price |
$16.96
|
| Rate for Payer: Cofinity Advantage |
$14.84
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.96
|
| Rate for Payer: Healthscope Commercial |
$19.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.90
|
| Rate for Payer: PHP Commercial |
$18.02
|
| Rate for Payer: Priority Health SBD |
$13.36
|
|
|
NAFCILLIN 2 GRAM IVPB (INTRA-OP)
|
Facility
|
OP
|
$21.20
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
168911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Aetna Commercial |
$18.02
|
| Rate for Payer: Aetna Medicare |
$10.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.78
|
| Rate for Payer: BCBS Complete |
$8.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$16.96
|
| Rate for Payer: Cash Price |
$16.96
|
| Rate for Payer: Cofinity Advantage |
$14.84
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.96
|
| Rate for Payer: Healthscope Commercial |
$19.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.90
|
| Rate for Payer: PHP Commercial |
$18.02
|
| Rate for Payer: Priority Health SBD |
$13.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
|
