|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$173.90
|
|
|
Service Code
|
NDC 536129801
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$173.90 |
| Rate for Payer: Aetna Commercial |
$156.51
|
| Rate for Payer: Aetna Medicare |
$64.34
|
| Rate for Payer: ASR ASR |
$168.68
|
| Rate for Payer: BCBS Complete |
$69.56
|
| Rate for Payer: BCBS Trust/PPO |
$143.38
|
| Rate for Payer: BCN Commercial |
$143.38
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$163.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$168.68
|
| Rate for Payer: Healthscope Whirlpool |
$173.90
|
| Rate for Payer: Mclaren Commercial |
$156.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Nomi Health Commercial |
$142.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$152.37
|
| Rate for Payer: Priority Health Narrow Network |
$121.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.03
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$1.48
|
|
|
Service Code
|
NDC 51079096601
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna Commercial |
$1.33
|
| Rate for Payer: ASR ASR |
$1.44
|
| Rate for Payer: BCBS Trust/PPO |
$1.22
|
| Rate for Payer: BCN Commercial |
$1.22
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.18
|
| Rate for Payer: Healthscope Commercial |
$1.44
|
| Rate for Payer: Healthscope Whirlpool |
$1.48
|
| Rate for Payer: Mclaren Commercial |
$1.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.26
|
| Rate for Payer: Nomi Health Commercial |
$1.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.30
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 536129801
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.43 |
| Max. Negotiated Rate |
$173.90 |
| Rate for Payer: Aetna Commercial |
$156.51
|
| Rate for Payer: ASR ASR |
$168.68
|
| Rate for Payer: BCBS Trust/PPO |
$142.81
|
| Rate for Payer: BCN Commercial |
$142.81
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$163.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$168.68
|
| Rate for Payer: Healthscope Whirlpool |
$173.90
|
| Rate for Payer: Mclaren Commercial |
$156.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Nomi Health Commercial |
$142.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.03
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
NDC 51079096620
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$148.05 |
| Rate for Payer: Aetna Commercial |
$133.25
|
| Rate for Payer: Aetna Medicare |
$54.78
|
| Rate for Payer: ASR ASR |
$143.61
|
| Rate for Payer: BCBS Complete |
$59.22
|
| Rate for Payer: BCBS Trust/PPO |
$122.07
|
| Rate for Payer: BCN Commercial |
$122.07
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$143.61
|
| Rate for Payer: Healthscope Whirlpool |
$148.05
|
| Rate for Payer: Mclaren Commercial |
$133.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Nomi Health Commercial |
$121.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$129.72
|
| Rate for Payer: Priority Health Narrow Network |
$103.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.28
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
HCPCS J1308
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna Commercial |
$11.65
|
| Rate for Payer: Aetna Commercial |
$14.67
|
| Rate for Payer: Aetna Commercial |
$10.81
|
| Rate for Payer: ASR ASR |
$15.81
|
| Rate for Payer: ASR ASR |
$14.84
|
| Rate for Payer: ASR ASR |
$12.56
|
| Rate for Payer: ASR ASR |
$11.65
|
| Rate for Payer: BCBS Trust/PPO |
$12.56
|
| Rate for Payer: BCBS Trust/PPO |
$9.86
|
| Rate for Payer: BCBS Trust/PPO |
$10.63
|
| Rate for Payer: BCBS Trust/PPO |
$13.39
|
| Rate for Payer: BCN Commercial |
$9.86
|
| Rate for Payer: BCN Commercial |
$13.39
|
| Rate for Payer: BCN Commercial |
$10.63
|
| Rate for Payer: BCN Commercial |
$12.56
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$10.36
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$15.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$14.84
|
| Rate for Payer: Healthscope Commercial |
$11.65
|
| Rate for Payer: Healthscope Commercial |
$12.56
|
| Rate for Payer: Healthscope Commercial |
$15.81
|
| Rate for Payer: Healthscope Whirlpool |
$15.30
|
| Rate for Payer: Healthscope Whirlpool |
$16.30
|
| Rate for Payer: Healthscope Whirlpool |
$12.01
|
| Rate for Payer: Healthscope Whirlpool |
$12.95
|
| Rate for Payer: Mclaren Commercial |
$10.81
|
| Rate for Payer: Mclaren Commercial |
$14.67
|
| Rate for Payer: Mclaren Commercial |
$11.65
|
| Rate for Payer: Mclaren Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.21
|
| Rate for Payer: Nomi Health Commercial |
$10.62
|
| Rate for Payer: Nomi Health Commercial |
$13.37
|
| Rate for Payer: Nomi Health Commercial |
$12.55
|
| Rate for Payer: Nomi Health Commercial |
$9.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.34
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.30
|
|
|
Service Code
|
HCPCS J1308
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$16.30 |
| Rate for Payer: Aetna Commercial |
$14.67
|
| Rate for Payer: Aetna Commercial |
$11.65
|
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna Commercial |
$10.81
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna Medicare |
$6.03
|
| Rate for Payer: Aetna Medicare |
$5.66
|
| Rate for Payer: Aetna Medicare |
$4.79
|
| Rate for Payer: ASR ASR |
$14.84
|
| Rate for Payer: ASR ASR |
$12.56
|
| Rate for Payer: ASR ASR |
$11.65
|
| Rate for Payer: ASR ASR |
$15.81
|
| Rate for Payer: BCBS Complete |
$6.12
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS Complete |
$6.52
|
| Rate for Payer: BCBS Complete |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$10.68
|
| Rate for Payer: BCBS Trust/PPO |
$13.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.61
|
| Rate for Payer: BCBS Trust/PPO |
$9.90
|
| Rate for Payer: BCN Commercial |
$13.44
|
| Rate for Payer: BCN Commercial |
$12.61
|
| Rate for Payer: BCN Commercial |
$9.90
|
| Rate for Payer: BCN Commercial |
$10.68
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$10.36
|
| Rate for Payer: Cash Price |
$10.36
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$15.32
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$15.81
|
| Rate for Payer: Healthscope Commercial |
$11.65
|
| Rate for Payer: Healthscope Commercial |
$12.56
|
| Rate for Payer: Healthscope Commercial |
$14.84
|
| Rate for Payer: Healthscope Whirlpool |
$12.01
|
| Rate for Payer: Healthscope Whirlpool |
$15.30
|
| Rate for Payer: Healthscope Whirlpool |
$16.30
|
| Rate for Payer: Healthscope Whirlpool |
$12.95
|
| Rate for Payer: Mclaren Commercial |
$13.77
|
| Rate for Payer: Mclaren Commercial |
$11.65
|
| Rate for Payer: Mclaren Commercial |
$10.81
|
| Rate for Payer: Mclaren Commercial |
$14.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.86
|
| Rate for Payer: Nomi Health Commercial |
$9.84
|
| Rate for Payer: Nomi Health Commercial |
$12.55
|
| Rate for Payer: Nomi Health Commercial |
$13.37
|
| Rate for Payer: Nomi Health Commercial |
$10.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.40
|
|
|
FAT EMULSION 20 % INTRAVENOUS
|
Facility
|
IP
|
$12.90
|
|
|
Service Code
|
NDC 65219053110
|
| Hospital Charge Code |
10014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$12.90 |
| Rate for Payer: Aetna Commercial |
$11.61
|
| Rate for Payer: ASR ASR |
$12.51
|
| Rate for Payer: BCBS Trust/PPO |
$10.59
|
| Rate for Payer: BCN Commercial |
$10.59
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$12.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$12.51
|
| Rate for Payer: Healthscope Whirlpool |
$12.90
|
| Rate for Payer: Mclaren Commercial |
$11.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.96
|
| Rate for Payer: Nomi Health Commercial |
$10.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.35
|
|
|
FAT EMULSION 20 % INTRAVENOUS
|
Facility
|
IP
|
$12.90
|
|
|
Service Code
|
NDC 65219053101
|
| Hospital Charge Code |
10014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$12.90 |
| Rate for Payer: Aetna Commercial |
$11.61
|
| Rate for Payer: ASR ASR |
$12.51
|
| Rate for Payer: BCBS Trust/PPO |
$10.59
|
| Rate for Payer: BCN Commercial |
$10.59
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$12.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$12.51
|
| Rate for Payer: Healthscope Whirlpool |
$12.90
|
| Rate for Payer: Mclaren Commercial |
$11.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.96
|
| Rate for Payer: Nomi Health Commercial |
$10.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.35
|
|
|
FAT EMULSION 20 % INTRAVENOUS
|
Facility
|
OP
|
$12.90
|
|
|
Service Code
|
NDC 65219053110
|
| Hospital Charge Code |
10014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$12.90 |
| Rate for Payer: Aetna Commercial |
$11.61
|
| Rate for Payer: Aetna Medicare |
$4.77
|
| Rate for Payer: ASR ASR |
$12.51
|
| Rate for Payer: BCBS Complete |
$5.16
|
| Rate for Payer: BCBS Trust/PPO |
$10.64
|
| Rate for Payer: BCN Commercial |
$10.64
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$12.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$12.51
|
| Rate for Payer: Healthscope Whirlpool |
$12.90
|
| Rate for Payer: Mclaren Commercial |
$11.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.96
|
| Rate for Payer: Nomi Health Commercial |
$10.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.30
|
| Rate for Payer: Priority Health Narrow Network |
$9.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.35
|
|
|
FAT EMULSION 20 % INTRAVENOUS
|
Facility
|
OP
|
$12.90
|
|
|
Service Code
|
NDC 65219053101
|
| Hospital Charge Code |
10014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$12.90 |
| Rate for Payer: Aetna Commercial |
$11.61
|
| Rate for Payer: Aetna Medicare |
$4.77
|
| Rate for Payer: ASR ASR |
$12.51
|
| Rate for Payer: BCBS Complete |
$5.16
|
| Rate for Payer: BCBS Trust/PPO |
$10.64
|
| Rate for Payer: BCN Commercial |
$10.64
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$12.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$12.51
|
| Rate for Payer: Healthscope Whirlpool |
$12.90
|
| Rate for Payer: Mclaren Commercial |
$11.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.96
|
| Rate for Payer: Nomi Health Commercial |
$10.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.30
|
| Rate for Payer: Priority Health Narrow Network |
$9.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.35
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
NDC 338954003
|
| Hospital Charge Code |
212074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.15
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: ASR ASR |
$13.10
|
| Rate for Payer: BCBS Complete |
$5.40
|
| Rate for Payer: BCBS Trust/PPO |
$11.13
|
| Rate for Payer: BCN Commercial |
$11.13
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$12.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$13.10
|
| Rate for Payer: Healthscope Whirlpool |
$13.50
|
| Rate for Payer: Mclaren Commercial |
$12.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: Nomi Health Commercial |
$11.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.83
|
| Rate for Payer: Priority Health Narrow Network |
$9.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.88
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
NDC 338954003
|
| Hospital Charge Code |
212074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.15
|
| Rate for Payer: ASR ASR |
$13.10
|
| Rate for Payer: BCBS Trust/PPO |
$11.09
|
| Rate for Payer: BCN Commercial |
$11.09
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$12.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$13.10
|
| Rate for Payer: Healthscope Whirlpool |
$13.50
|
| Rate for Payer: Mclaren Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: Nomi Health Commercial |
$11.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.88
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
NDC 63323082074
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Medicare |
$8.88
|
| Rate for Payer: ASR ASR |
$23.28
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$19.79
|
| Rate for Payer: BCN Commercial |
$19.79
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$22.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$23.28
|
| Rate for Payer: Healthscope Whirlpool |
$24.00
|
| Rate for Payer: Mclaren Commercial |
$21.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.40
|
| Rate for Payer: Nomi Health Commercial |
$19.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21.03
|
| Rate for Payer: Priority Health Narrow Network |
$16.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.12
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
NDC 63323082074
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: ASR ASR |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$19.71
|
| Rate for Payer: BCN Commercial |
$19.71
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$22.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$23.28
|
| Rate for Payer: Healthscope Whirlpool |
$24.00
|
| Rate for Payer: Mclaren Commercial |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.40
|
| Rate for Payer: Nomi Health Commercial |
$19.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.12
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$5,364.49
|
|
|
Service Code
|
APR-DRG 5313
|
| Min. Negotiated Rate |
$4,850.14 |
| Max. Negotiated Rate |
$5,364.49 |
| Rate for Payer: BCBS Complete |
$5,364.49
|
| Rate for Payer: Mclaren Medicaid |
$5,109.04
|
| Rate for Payer: Meridian Medicaid |
$5,364.49
|
| Rate for Payer: PHP Medicaid |
$4,850.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,109.04
|
| Rate for Payer: UHC Medicaid |
$5,109.04
|
| Rate for Payer: UHCCP Medicaid |
$5,109.04
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$8,433.65
|
|
|
Service Code
|
APR-DRG 5314
|
| Min. Negotiated Rate |
$7,625.03 |
| Max. Negotiated Rate |
$8,433.65 |
| Rate for Payer: BCBS Complete |
$8,433.65
|
| Rate for Payer: Mclaren Medicaid |
$8,032.04
|
| Rate for Payer: Meridian Medicaid |
$8,433.65
|
| Rate for Payer: PHP Medicaid |
$7,625.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,032.04
|
| Rate for Payer: UHC Medicaid |
$8,032.04
|
| Rate for Payer: UHCCP Medicaid |
$8,032.04
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$2,950.36
|
|
|
Service Code
|
APR-DRG 5311
|
| Min. Negotiated Rate |
$2,667.48 |
| Max. Negotiated Rate |
$2,950.36 |
| Rate for Payer: BCBS Complete |
$2,950.36
|
| Rate for Payer: Mclaren Medicaid |
$2,809.87
|
| Rate for Payer: Meridian Medicaid |
$2,950.36
|
| Rate for Payer: PHP Medicaid |
$2,667.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,809.87
|
| Rate for Payer: UHC Medicaid |
$2,809.87
|
| Rate for Payer: UHCCP Medicaid |
$2,809.87
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$3,992.30
|
|
|
Service Code
|
APR-DRG 5312
|
| Min. Negotiated Rate |
$3,609.52 |
| Max. Negotiated Rate |
$3,992.30 |
| Rate for Payer: BCBS Complete |
$3,992.30
|
| Rate for Payer: Mclaren Medicaid |
$3,802.19
|
| Rate for Payer: Meridian Medicaid |
$3,992.30
|
| Rate for Payer: PHP Medicaid |
$3,609.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,802.19
|
| Rate for Payer: UHC Medicaid |
$3,802.19
|
| Rate for Payer: UHCCP Medicaid |
$3,802.19
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$7,711.04
|
|
|
Service Code
|
APR-DRG 5303
|
| Min. Negotiated Rate |
$6,971.70 |
| Max. Negotiated Rate |
$7,711.04 |
| Rate for Payer: BCBS Complete |
$7,711.04
|
| Rate for Payer: Mclaren Medicaid |
$7,343.85
|
| Rate for Payer: Meridian Medicaid |
$7,711.04
|
| Rate for Payer: PHP Medicaid |
$6,971.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,343.85
|
| Rate for Payer: UHC Medicaid |
$7,343.85
|
| Rate for Payer: UHCCP Medicaid |
$7,343.85
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$4,441.34
|
|
|
Service Code
|
APR-DRG 5301
|
| Min. Negotiated Rate |
$4,015.51 |
| Max. Negotiated Rate |
$4,441.34 |
| Rate for Payer: BCBS Complete |
$4,441.34
|
| Rate for Payer: Mclaren Medicaid |
$4,229.85
|
| Rate for Payer: Meridian Medicaid |
$4,441.34
|
| Rate for Payer: PHP Medicaid |
$4,015.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,229.85
|
| Rate for Payer: UHC Medicaid |
$4,229.85
|
| Rate for Payer: UHCCP Medicaid |
$4,229.85
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$5,795.54
|
|
|
Service Code
|
APR-DRG 5302
|
| Min. Negotiated Rate |
$5,239.86 |
| Max. Negotiated Rate |
$5,795.54 |
| Rate for Payer: BCBS Complete |
$5,795.54
|
| Rate for Payer: Mclaren Medicaid |
$5,519.56
|
| Rate for Payer: Meridian Medicaid |
$5,795.54
|
| Rate for Payer: PHP Medicaid |
$5,239.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,519.56
|
| Rate for Payer: UHC Medicaid |
$5,519.56
|
| Rate for Payer: UHCCP Medicaid |
$5,519.56
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$13,392.69
|
|
|
Service Code
|
APR-DRG 5304
|
| Min. Negotiated Rate |
$12,108.60 |
| Max. Negotiated Rate |
$13,392.69 |
| Rate for Payer: BCBS Complete |
$13,392.69
|
| Rate for Payer: Mclaren Medicaid |
$12,754.94
|
| Rate for Payer: Meridian Medicaid |
$13,392.69
|
| Rate for Payer: PHP Medicaid |
$12,108.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,754.94
|
| Rate for Payer: UHC Medicaid |
$12,754.94
|
| Rate for Payer: UHCCP Medicaid |
$12,754.94
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$13,591.60
|
|
|
Service Code
|
APR-DRG 5143
|
| Min. Negotiated Rate |
$12,288.43 |
| Max. Negotiated Rate |
$13,591.60 |
| Rate for Payer: BCBS Complete |
$13,591.60
|
| Rate for Payer: Mclaren Medicaid |
$12,944.38
|
| Rate for Payer: Meridian Medicaid |
$13,591.60
|
| Rate for Payer: PHP Medicaid |
$12,288.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,944.38
|
| Rate for Payer: UHC Medicaid |
$12,944.38
|
| Rate for Payer: UHCCP Medicaid |
$12,944.38
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$7,505.60
|
|
|
Service Code
|
APR-DRG 5141
|
| Min. Negotiated Rate |
$6,785.96 |
| Max. Negotiated Rate |
$7,505.60 |
| Rate for Payer: BCBS Complete |
$7,505.60
|
| Rate for Payer: Mclaren Medicaid |
$7,148.19
|
| Rate for Payer: Meridian Medicaid |
$7,505.60
|
| Rate for Payer: PHP Medicaid |
$6,785.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,148.19
|
| Rate for Payer: UHC Medicaid |
$7,148.19
|
| Rate for Payer: UHCCP Medicaid |
$7,148.19
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$19,059.84
|
|
|
Service Code
|
MSDRG 748
|
| Min. Negotiated Rate |
$11,157.51 |
| Max. Negotiated Rate |
$19,059.84 |
| Rate for Payer: Aetna Medicare |
$11,744.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,680.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,680.94
|
| Rate for Payer: BCBS MAPPO |
$11,744.75
|
| Rate for Payer: BCN Medicare Advantage |
$11,744.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,744.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,744.75
|
| Rate for Payer: Mclaren Medicare |
$11,744.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,331.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,506.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,919.23
|
| Rate for Payer: PACE Medicare |
$11,157.51
|
| Rate for Payer: PACE SWMI |
$11,744.75
|
| Rate for Payer: PHP Commercial |
$12,919.23
|
| Rate for Payer: PHP Medicare Advantage |
$11,744.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19,059.84
|
| Rate for Payer: Priority Health Medicare |
$11,744.75
|
| Rate for Payer: Priority Health Narrow Network |
$15,247.87
|
| Rate for Payer: Railroad Medicare Medicare |
$11,744.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,744.75
|
| Rate for Payer: UHC Exchange |
$18,204.36
|
| Rate for Payer: UHCCP DNSP |
$11,744.75
|
| Rate for Payer: VA VA |
$11,744.75
|
|
