|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$23.27
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
21063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$23.27 |
| Rate for Payer: Aetna Commercial |
$20.94
|
| Rate for Payer: Aetna Commercial |
$18.09
|
| Rate for Payer: Aetna Commercial |
$15.71
|
| Rate for Payer: Aetna Commercial |
$27.64
|
| Rate for Payer: Aetna Commercial |
$25.70
|
| Rate for Payer: Aetna Commercial |
$24.27
|
| Rate for Payer: Aetna Commercial |
$18.68
|
| Rate for Payer: ASR ASR |
$26.16
|
| Rate for Payer: ASR ASR |
$16.94
|
| Rate for Payer: ASR ASR |
$19.50
|
| Rate for Payer: ASR ASR |
$20.14
|
| Rate for Payer: ASR ASR |
$22.57
|
| Rate for Payer: ASR ASR |
$27.69
|
| Rate for Payer: ASR ASR |
$29.79
|
| Rate for Payer: BCBS Trust/PPO |
$16.10
|
| Rate for Payer: BCBS Trust/PPO |
$20.91
|
| Rate for Payer: BCBS Trust/PPO |
$22.13
|
| Rate for Payer: BCBS Trust/PPO |
$15.58
|
| Rate for Payer: BCBS Trust/PPO |
$18.04
|
| Rate for Payer: BCBS Trust/PPO |
$13.54
|
| Rate for Payer: BCBS Trust/PPO |
$23.81
|
| Rate for Payer: BCN Commercial |
$23.81
|
| Rate for Payer: BCN Commercial |
$16.10
|
| Rate for Payer: BCN Commercial |
$20.91
|
| Rate for Payer: BCN Commercial |
$13.54
|
| Rate for Payer: BCN Commercial |
$15.58
|
| Rate for Payer: BCN Commercial |
$22.13
|
| Rate for Payer: BCN Commercial |
$18.04
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$22.84
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$25.35
|
| Rate for Payer: Cofinity Commercial |
$16.41
|
| Rate for Payer: Cofinity Commercial |
$21.87
|
| Rate for Payer: Cofinity Commercial |
$28.87
|
| Rate for Payer: Cofinity Commercial |
$19.51
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Commercial |
$18.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.61
|
| Rate for Payer: Healthscope Commercial |
$20.76
|
| Rate for Payer: Healthscope Commercial |
$30.71
|
| Rate for Payer: Healthscope Commercial |
$26.97
|
| Rate for Payer: Healthscope Commercial |
$28.55
|
| Rate for Payer: Healthscope Commercial |
$23.27
|
| Rate for Payer: Healthscope Commercial |
$20.10
|
| Rate for Payer: Healthscope Commercial |
$17.46
|
| Rate for Payer: Healthscope Whirlpool |
$16.94
|
| Rate for Payer: Healthscope Whirlpool |
$19.50
|
| Rate for Payer: Healthscope Whirlpool |
$20.14
|
| Rate for Payer: Healthscope Whirlpool |
$22.57
|
| Rate for Payer: Healthscope Whirlpool |
$26.16
|
| Rate for Payer: Healthscope Whirlpool |
$27.69
|
| Rate for Payer: Healthscope Whirlpool |
$29.79
|
| Rate for Payer: Mclaren Commercial |
$18.68
|
| Rate for Payer: Mclaren Commercial |
$25.70
|
| Rate for Payer: Mclaren Commercial |
$15.71
|
| Rate for Payer: Mclaren Commercial |
$27.64
|
| Rate for Payer: Mclaren Commercial |
$18.09
|
| Rate for Payer: Mclaren Commercial |
$24.27
|
| Rate for Payer: Mclaren Commercial |
$20.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.73
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
IP
|
$250.42
|
|
|
Service Code
|
NDC 50268-099-13
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.29 |
| Max. Negotiated Rate |
$250.42 |
| Rate for Payer: Aetna Commercial |
$225.38
|
| Rate for Payer: ASR ASR |
$242.91
|
| Rate for Payer: BCBS Trust/PPO |
$194.15
|
| Rate for Payer: BCN Commercial |
$194.15
|
| Rate for Payer: Cash Price |
$200.33
|
| Rate for Payer: Cofinity Commercial |
$235.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.34
|
| Rate for Payer: Healthscope Commercial |
$250.42
|
| Rate for Payer: Healthscope Whirlpool |
$242.91
|
| Rate for Payer: Mclaren Commercial |
$225.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.37
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
IP
|
$8.35
|
|
|
Service Code
|
NDC 50268-099-11
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: ASR ASR |
$8.10
|
| Rate for Payer: BCBS Trust/PPO |
$6.47
|
| Rate for Payer: BCN Commercial |
$6.47
|
| Rate for Payer: Cash Price |
$6.68
|
| Rate for Payer: Cofinity Commercial |
$7.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$8.35
|
| Rate for Payer: Healthscope Whirlpool |
$8.10
|
| Rate for Payer: Mclaren Commercial |
$7.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.35
|
|
|
AZITHROMYCIN 500 MG TABLET
|
Facility
IP
|
$498.06
|
|
|
Service Code
|
NDC 50111-788-10
|
| Hospital Charge Code |
17482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$348.64 |
| Max. Negotiated Rate |
$498.06 |
| Rate for Payer: Aetna Commercial |
$448.25
|
| Rate for Payer: ASR ASR |
$483.12
|
| Rate for Payer: BCBS Trust/PPO |
$386.15
|
| Rate for Payer: BCN Commercial |
$386.15
|
| Rate for Payer: Cash Price |
$398.45
|
| Rate for Payer: Cofinity Commercial |
$468.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.45
|
| Rate for Payer: Healthscope Commercial |
$498.06
|
| Rate for Payer: Healthscope Whirlpool |
$483.12
|
| Rate for Payer: Mclaren Commercial |
$448.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$423.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$438.29
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$123.02
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.11 |
| Max. Negotiated Rate |
$123.02 |
| Rate for Payer: Aetna Commercial |
$110.72
|
| Rate for Payer: Aetna Commercial |
$89.35
|
| Rate for Payer: Aetna Commercial |
$89.39
|
| Rate for Payer: ASR ASR |
$119.33
|
| Rate for Payer: ASR ASR |
$96.30
|
| Rate for Payer: ASR ASR |
$96.34
|
| Rate for Payer: BCBS Trust/PPO |
$77.00
|
| Rate for Payer: BCBS Trust/PPO |
$95.38
|
| Rate for Payer: BCBS Trust/PPO |
$76.97
|
| Rate for Payer: BCN Commercial |
$95.38
|
| Rate for Payer: BCN Commercial |
$77.00
|
| Rate for Payer: BCN Commercial |
$76.97
|
| Rate for Payer: Cash Price |
$79.43
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Cash Price |
$98.41
|
| Rate for Payer: Cofinity Commercial |
$115.64
|
| Rate for Payer: Cofinity Commercial |
$93.36
|
| Rate for Payer: Cofinity Commercial |
$93.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.42
|
| Rate for Payer: Healthscope Commercial |
$99.32
|
| Rate for Payer: Healthscope Commercial |
$123.02
|
| Rate for Payer: Healthscope Commercial |
$99.28
|
| Rate for Payer: Healthscope Whirlpool |
$96.34
|
| Rate for Payer: Healthscope Whirlpool |
$96.30
|
| Rate for Payer: Healthscope Whirlpool |
$119.33
|
| Rate for Payer: Mclaren Commercial |
$89.35
|
| Rate for Payer: Mclaren Commercial |
$110.72
|
| Rate for Payer: Mclaren Commercial |
$89.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.37
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$196.28
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.40 |
| Max. Negotiated Rate |
$196.28 |
| Rate for Payer: Aetna Commercial |
$176.65
|
| Rate for Payer: Aetna Commercial |
$182.48
|
| Rate for Payer: Aetna Commercial |
$182.51
|
| Rate for Payer: ASR ASR |
$190.39
|
| Rate for Payer: ASR ASR |
$196.71
|
| Rate for Payer: ASR ASR |
$196.67
|
| Rate for Payer: BCBS Trust/PPO |
$157.22
|
| Rate for Payer: BCBS Trust/PPO |
$152.18
|
| Rate for Payer: BCBS Trust/PPO |
$157.19
|
| Rate for Payer: BCN Commercial |
$157.19
|
| Rate for Payer: BCN Commercial |
$152.18
|
| Rate for Payer: BCN Commercial |
$157.22
|
| Rate for Payer: Cash Price |
$162.20
|
| Rate for Payer: Cash Price |
$162.23
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cofinity Commercial |
$190.62
|
| Rate for Payer: Cofinity Commercial |
$184.50
|
| Rate for Payer: Cofinity Commercial |
$190.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.02
|
| Rate for Payer: Healthscope Commercial |
$202.75
|
| Rate for Payer: Healthscope Commercial |
$202.79
|
| Rate for Payer: Healthscope Commercial |
$196.28
|
| Rate for Payer: Healthscope Whirlpool |
$196.67
|
| Rate for Payer: Healthscope Whirlpool |
$190.39
|
| Rate for Payer: Healthscope Whirlpool |
$196.71
|
| Rate for Payer: Mclaren Commercial |
$182.48
|
| Rate for Payer: Mclaren Commercial |
$182.51
|
| Rate for Payer: Mclaren Commercial |
$176.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.46
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
IP
|
$9.90
|
|
|
Service Code
|
NDC 1678411631
|
| Hospital Charge Code |
850
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: ASR ASR |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$7.68
|
| Rate for Payer: BCN Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Healthscope Whirlpool |
$9.60
|
| Rate for Payer: Mclaren Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.71
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
IP
|
$10.22
|
|
|
Service Code
|
NDC 1678411731
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$10.22 |
| Rate for Payer: Aetna Commercial |
$9.20
|
| Rate for Payer: ASR ASR |
$9.91
|
| Rate for Payer: BCBS Trust/PPO |
$7.92
|
| Rate for Payer: BCN Commercial |
$7.92
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$9.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Healthscope Commercial |
$10.22
|
| Rate for Payer: Healthscope Whirlpool |
$9.91
|
| Rate for Payer: Mclaren Commercial |
$9.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.99
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC
|
Facility
IP
|
$25,276.82
|
|
|
Service Code
|
MS-DRG 519
|
| Min. Negotiated Rate |
$17,430.50 |
| Max. Negotiated Rate |
$25,276.82 |
| Rate for Payer: Aetna Medicare |
$18,347.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,934.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,934.86
|
| Rate for Payer: BCBS MAPPO |
$18,347.89
|
| Rate for Payer: BCN Medicare Advantage |
$18,347.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,347.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,347.89
|
| Rate for Payer: Mclaren Medicare |
$18,347.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,265.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,100.07
|
| Rate for Payer: PACE Medicare |
$17,430.50
|
| Rate for Payer: PACE SWMI |
$18,347.89
|
| Rate for Payer: PHP Commercial |
$20,182.68
|
| Rate for Payer: PHP Medicare Advantage |
$18,347.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,276.82
|
| Rate for Payer: Priority Health Medicare |
$18,347.89
|
| Rate for Payer: Priority Health Narrow Network |
$20,221.46
|
| Rate for Payer: Railroad Medicare Medicare |
$18,347.89
|
| Rate for Payer: UHC Medicare Advantage |
$18,898.33
|
| Rate for Payer: VA VA |
$18,347.89
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR
|
Facility
IP
|
$46,889.11
|
|
|
Service Code
|
MS-DRG 518
|
| Min. Negotiated Rate |
$30,968.60 |
| Max. Negotiated Rate |
$46,889.11 |
| Rate for Payer: Aetna Medicare |
$32,598.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40,748.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40,748.16
|
| Rate for Payer: BCBS MAPPO |
$32,598.53
|
| Rate for Payer: BCN Medicare Advantage |
$32,598.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32,598.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$32,598.53
|
| Rate for Payer: Mclaren Medicare |
$32,598.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34,228.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37,488.31
|
| Rate for Payer: PACE Medicare |
$30,968.60
|
| Rate for Payer: PACE SWMI |
$32,598.53
|
| Rate for Payer: PHP Commercial |
$35,858.38
|
| Rate for Payer: PHP Medicare Advantage |
$32,598.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46,889.11
|
| Rate for Payer: Priority Health Medicare |
$32,598.53
|
| Rate for Payer: Priority Health Narrow Network |
$37,511.29
|
| Rate for Payer: Railroad Medicare Medicare |
$32,598.53
|
| Rate for Payer: UHC Medicare Advantage |
$33,576.49
|
| Rate for Payer: VA VA |
$32,598.53
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC
|
Facility
IP
|
$18,380.46
|
|
|
Service Code
|
MS-DRG 520
|
| Min. Negotiated Rate |
$13,110.56 |
| Max. Negotiated Rate |
$18,380.46 |
| Rate for Payer: Aetna Medicare |
$13,800.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,250.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,250.74
|
| Rate for Payer: BCBS MAPPO |
$13,800.59
|
| Rate for Payer: BCN Medicare Advantage |
$13,800.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,800.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,800.59
|
| Rate for Payer: Mclaren Medicare |
$13,800.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,490.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,870.68
|
| Rate for Payer: PACE Medicare |
$13,110.56
|
| Rate for Payer: PACE SWMI |
$13,800.59
|
| Rate for Payer: PHP Commercial |
$15,180.65
|
| Rate for Payer: PHP Medicare Advantage |
$13,800.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,380.46
|
| Rate for Payer: Priority Health Medicare |
$13,800.59
|
| Rate for Payer: Priority Health Narrow Network |
$14,704.37
|
| Rate for Payer: Railroad Medicare Medicare |
$13,800.59
|
| Rate for Payer: UHC Medicare Advantage |
$14,214.61
|
| Rate for Payer: VA VA |
$13,800.59
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
IP
|
$331.55
|
|
|
Service Code
|
NDC 0904-6475-61
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.08 |
| Max. Negotiated Rate |
$331.55 |
| Rate for Payer: Aetna Commercial |
$298.40
|
| Rate for Payer: ASR ASR |
$321.60
|
| Rate for Payer: BCBS Trust/PPO |
$257.05
|
| Rate for Payer: BCN Commercial |
$257.05
|
| Rate for Payer: Cash Price |
$265.24
|
| Rate for Payer: Cofinity Commercial |
$311.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.24
|
| Rate for Payer: Healthscope Commercial |
$331.55
|
| Rate for Payer: Healthscope Whirlpool |
$321.60
|
| Rate for Payer: Mclaren Commercial |
$298.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$291.76
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC
|
Facility
IP
|
$30,613.13
|
|
|
Service Code
|
MS-DRG 095
|
| Min. Negotiated Rate |
$20,773.18 |
| Max. Negotiated Rate |
$30,613.13 |
| Rate for Payer: Aetna Medicare |
$21,866.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,333.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,333.14
|
| Rate for Payer: BCBS MAPPO |
$21,866.51
|
| Rate for Payer: BCN Medicare Advantage |
$21,866.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,866.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$21,866.51
|
| Rate for Payer: Mclaren Medicare |
$21,866.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,959.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,146.49
|
| Rate for Payer: PACE Medicare |
$20,773.18
|
| Rate for Payer: PACE SWMI |
$21,866.51
|
| Rate for Payer: PHP Commercial |
$24,053.16
|
| Rate for Payer: PHP Medicare Advantage |
$21,866.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,613.13
|
| Rate for Payer: Priority Health Medicare |
$21,866.51
|
| Rate for Payer: Priority Health Narrow Network |
$24,490.50
|
| Rate for Payer: Railroad Medicare Medicare |
$21,866.51
|
| Rate for Payer: UHC Medicare Advantage |
$22,522.51
|
| Rate for Payer: VA VA |
$21,866.51
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC
|
Facility
IP
|
$46,515.47
|
|
|
Service Code
|
MS-DRG 094
|
| Min. Negotiated Rate |
$30,734.54 |
| Max. Negotiated Rate |
$46,515.47 |
| Rate for Payer: Aetna Medicare |
$32,352.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40,440.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40,440.19
|
| Rate for Payer: BCBS MAPPO |
$32,352.15
|
| Rate for Payer: BCN Medicare Advantage |
$32,352.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32,352.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$32,352.15
|
| Rate for Payer: Mclaren Medicare |
$32,352.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33,969.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37,204.97
|
| Rate for Payer: PACE Medicare |
$30,734.54
|
| Rate for Payer: PACE SWMI |
$32,352.15
|
| Rate for Payer: PHP Commercial |
$35,587.36
|
| Rate for Payer: PHP Medicare Advantage |
$32,352.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46,515.47
|
| Rate for Payer: Priority Health Medicare |
$32,352.15
|
| Rate for Payer: Priority Health Narrow Network |
$37,212.38
|
| Rate for Payer: Railroad Medicare Medicare |
$32,352.15
|
| Rate for Payer: UHC Medicare Advantage |
$33,322.71
|
| Rate for Payer: VA VA |
$32,352.15
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC
|
Facility
IP
|
$27,987.35
|
|
|
Service Code
|
MS-DRG 096
|
| Min. Negotiated Rate |
$19,128.39 |
| Max. Negotiated Rate |
$27,987.35 |
| Rate for Payer: Aetna Medicare |
$20,135.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,168.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,168.94
|
| Rate for Payer: BCBS MAPPO |
$20,135.15
|
| Rate for Payer: BCN Medicare Advantage |
$20,135.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,135.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$20,135.15
|
| Rate for Payer: Mclaren Medicare |
$20,135.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,141.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,155.42
|
| Rate for Payer: PACE Medicare |
$19,128.39
|
| Rate for Payer: PACE SWMI |
$20,135.15
|
| Rate for Payer: PHP Commercial |
$22,148.66
|
| Rate for Payer: PHP Medicare Advantage |
$20,135.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,987.35
|
| Rate for Payer: Priority Health Medicare |
$20,135.15
|
| Rate for Payer: Priority Health Narrow Network |
$22,389.88
|
| Rate for Payer: Railroad Medicare Medicare |
$20,135.15
|
| Rate for Payer: UHC Medicare Advantage |
$20,739.20
|
| Rate for Payer: VA VA |
$20,135.15
|
|
|
BARIUM SULFATE 700 MG TABLET
|
Facility
IP
|
$340.32
|
|
|
Service Code
|
NDC 10361-778-31
|
| Hospital Charge Code |
100992
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$238.22 |
| Max. Negotiated Rate |
$340.32 |
| Rate for Payer: Aetna Commercial |
$306.29
|
| Rate for Payer: ASR ASR |
$330.11
|
| Rate for Payer: BCBS Trust/PPO |
$263.85
|
| Rate for Payer: BCN Commercial |
$263.85
|
| Rate for Payer: Cash Price |
$272.26
|
| Rate for Payer: Cofinity Commercial |
$319.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.26
|
| Rate for Payer: Healthscope Commercial |
$340.32
|
| Rate for Payer: Healthscope Whirlpool |
$330.11
|
| Rate for Payer: Mclaren Commercial |
$306.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.48
|
|
|
BARIUM SULFATE 98 % ORAL POWDER FOR SUSPENSION
|
Facility
IP
|
$5.38
|
|
|
Service Code
|
NDC 32909-764-01
|
| Hospital Charge Code |
19436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$5.38 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: ASR ASR |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.17
|
| Rate for Payer: BCN Commercial |
$4.17
|
| Rate for Payer: Cash Price |
$4.30
|
| Rate for Payer: Cofinity Commercial |
$5.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.30
|
| Rate for Payer: Healthscope Commercial |
$5.38
|
| Rate for Payer: Healthscope Whirlpool |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$4.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.73
|
|
|
BEHAVIORAL AND DEVELOPMENTAL DISORDERS
|
Facility
IP
|
$21,593.03
|
|
|
Service Code
|
MS-DRG 886
|
| Min. Negotiated Rate |
$15,122.94 |
| Max. Negotiated Rate |
$21,593.03 |
| Rate for Payer: Aetna Medicare |
$15,918.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,898.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,898.60
|
| Rate for Payer: BCBS MAPPO |
$15,918.88
|
| Rate for Payer: BCN Medicare Advantage |
$15,918.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,918.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,918.88
|
| Rate for Payer: Mclaren Medicare |
$15,918.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,714.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,306.71
|
| Rate for Payer: PACE Medicare |
$15,122.94
|
| Rate for Payer: PACE SWMI |
$15,918.88
|
| Rate for Payer: PHP Commercial |
$17,510.77
|
| Rate for Payer: PHP Medicare Advantage |
$15,918.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,593.03
|
| Rate for Payer: Priority Health Medicare |
$15,918.88
|
| Rate for Payer: Priority Health Narrow Network |
$17,274.42
|
| Rate for Payer: Railroad Medicare Medicare |
$15,918.88
|
| Rate for Payer: UHC Medicare Advantage |
$16,396.45
|
| Rate for Payer: VA VA |
$15,918.88
|
|
|
BENAZEPRIL 5 MG TABLET
|
Facility
IP
|
$225.62
|
|
|
Service Code
|
NDC 50268-109-15
|
| Hospital Charge Code |
9223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.93 |
| Max. Negotiated Rate |
$225.62 |
| Rate for Payer: Aetna Commercial |
$203.06
|
| Rate for Payer: ASR ASR |
$218.85
|
| Rate for Payer: BCBS Trust/PPO |
$174.92
|
| Rate for Payer: BCN Commercial |
$174.92
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cofinity Commercial |
$212.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.50
|
| Rate for Payer: Healthscope Commercial |
$225.62
|
| Rate for Payer: Healthscope Whirlpool |
$218.85
|
| Rate for Payer: Mclaren Commercial |
$203.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.55
|
|
|
BENAZEPRIL 5 MG TABLET
|
Facility
IP
|
$4.51
|
|
|
Service Code
|
NDC 50268-109-11
|
| Hospital Charge Code |
9223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna Commercial |
$4.06
|
| Rate for Payer: ASR ASR |
$4.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.50
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cofinity Commercial |
$4.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.61
|
| Rate for Payer: Healthscope Commercial |
$4.51
|
| Rate for Payer: Healthscope Whirlpool |
$4.37
|
| Rate for Payer: Mclaren Commercial |
$4.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.97
|
|
|
BENAZEPRIL 5 MG TABLET
|
Facility
IP
|
$152.75
|
|
|
Service Code
|
NDC 65162-751-10
|
| Hospital Charge Code |
9223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.92 |
| Max. Negotiated Rate |
$152.75 |
| Rate for Payer: Aetna Commercial |
$137.48
|
| Rate for Payer: ASR ASR |
$148.17
|
| Rate for Payer: BCBS Trust/PPO |
$118.43
|
| Rate for Payer: BCN Commercial |
$118.43
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Commercial |
$143.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$152.75
|
| Rate for Payer: Healthscope Whirlpool |
$148.17
|
| Rate for Payer: Mclaren Commercial |
$137.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.42
|
|
|
BENAZEPRIL 5 MG TABLET
|
Facility
IP
|
$357.20
|
|
|
Service Code
|
NDC 0185-0505-01
|
| Hospital Charge Code |
9223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.04 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Aetna Commercial |
$321.48
|
| Rate for Payer: ASR ASR |
$346.48
|
| Rate for Payer: BCBS Trust/PPO |
$276.94
|
| Rate for Payer: BCN Commercial |
$276.94
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$335.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Healthscope Commercial |
$357.20
|
| Rate for Payer: Healthscope Whirlpool |
$346.48
|
| Rate for Payer: Mclaren Commercial |
$321.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.34
|
|
|
BENIGN PROSTATIC HYPERTROPHY WITH MCC
|
Facility
IP
|
$15,933.16
|
|
|
Service Code
|
MS-DRG 725
|
| Min. Negotiated Rate |
$11,577.55 |
| Max. Negotiated Rate |
$15,933.16 |
| Rate for Payer: Aetna Medicare |
$12,186.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,233.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,233.61
|
| Rate for Payer: BCBS MAPPO |
$12,186.89
|
| Rate for Payer: BCN Medicare Advantage |
$12,186.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,186.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,186.89
|
| Rate for Payer: Mclaren Medicare |
$12,186.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,796.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,014.92
|
| Rate for Payer: PACE Medicare |
$11,577.55
|
| Rate for Payer: PACE SWMI |
$12,186.89
|
| Rate for Payer: PHP Commercial |
$13,405.58
|
| Rate for Payer: PHP Medicare Advantage |
$12,186.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,933.16
|
| Rate for Payer: Priority Health Medicare |
$12,186.89
|
| Rate for Payer: Priority Health Narrow Network |
$12,746.53
|
| Rate for Payer: Railroad Medicare Medicare |
$12,186.89
|
| Rate for Payer: UHC Medicare Advantage |
$12,552.50
|
| Rate for Payer: VA VA |
$12,186.89
|
|
|
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC
|
Facility
IP
|
$9,836.29
|
|
|
Service Code
|
MS-DRG 726
|
| Min. Negotiated Rate |
$7,475.58 |
| Max. Negotiated Rate |
$9,836.29 |
| Rate for Payer: Aetna Medicare |
$7,869.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,836.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,836.29
|
| Rate for Payer: BCBS MAPPO |
$7,869.03
|
| Rate for Payer: BCN Medicare Advantage |
$7,869.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,869.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,869.03
|
| Rate for Payer: Mclaren Medicare |
$7,869.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,262.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,049.38
|
| Rate for Payer: PACE Medicare |
$7,475.58
|
| Rate for Payer: PACE SWMI |
$7,869.03
|
| Rate for Payer: PHP Commercial |
$8,655.93
|
| Rate for Payer: PHP Medicare Advantage |
$7,869.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,384.76
|
| Rate for Payer: Priority Health Medicare |
$7,869.03
|
| Rate for Payer: Priority Health Narrow Network |
$7,507.81
|
| Rate for Payer: Railroad Medicare Medicare |
$7,869.03
|
| Rate for Payer: UHC Medicare Advantage |
$8,105.10
|
| Rate for Payer: VA VA |
$7,869.03
|
|
|
BENRALIZUMAB 30 MG/ML SUBCUTANEOUS AUTO-INJECTOR
|
Facility
IP
|
$21,003.97
|
|
|
Service Code
|
HCPCS J0517
|
| Hospital Charge Code |
191757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14,702.78 |
| Max. Negotiated Rate |
$21,003.97 |
| Rate for Payer: Aetna Commercial |
$18,903.57
|
| Rate for Payer: ASR ASR |
$20,373.85
|
| Rate for Payer: BCBS Trust/PPO |
$16,284.38
|
| Rate for Payer: BCN Commercial |
$16,284.38
|
| Rate for Payer: Cash Price |
$16,803.18
|
| Rate for Payer: Cofinity Commercial |
$19,743.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,803.18
|
| Rate for Payer: Healthscope Commercial |
$21,003.97
|
| Rate for Payer: Healthscope Whirlpool |
$20,373.85
|
| Rate for Payer: Mclaren Commercial |
$18,903.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17,853.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,702.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18,483.49
|
|
