|
BENRALIZUMAB 30 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
IP
|
$18,588.50
|
|
|
Service Code
|
HCPCS J0517
|
| Hospital Charge Code |
185161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,011.95 |
| Max. Negotiated Rate |
$18,588.50 |
| Rate for Payer: Aetna Commercial |
$16,729.65
|
| Rate for Payer: ASR ASR |
$18,030.84
|
| Rate for Payer: BCBS Trust/PPO |
$14,411.66
|
| Rate for Payer: BCN Commercial |
$14,411.66
|
| Rate for Payer: Cash Price |
$14,870.80
|
| Rate for Payer: Cofinity Commercial |
$17,473.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,870.80
|
| Rate for Payer: Healthscope Commercial |
$18,588.50
|
| Rate for Payer: Healthscope Whirlpool |
$18,030.84
|
| Rate for Payer: Mclaren Commercial |
$16,729.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,800.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,011.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,357.88
|
|
|
BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES
|
Facility
IP
|
$43.99
|
|
|
Service Code
|
NDC 63824-713-16
|
| Hospital Charge Code |
153363
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.79 |
| Max. Negotiated Rate |
$43.99 |
| Rate for Payer: Aetna Commercial |
$39.59
|
| Rate for Payer: ASR ASR |
$42.67
|
| Rate for Payer: BCBS Trust/PPO |
$34.11
|
| Rate for Payer: BCN Commercial |
$34.11
|
| Rate for Payer: Cash Price |
$35.19
|
| Rate for Payer: Cofinity Commercial |
$41.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.19
|
| Rate for Payer: Healthscope Commercial |
$43.99
|
| Rate for Payer: Healthscope Whirlpool |
$42.67
|
| Rate for Payer: Mclaren Commercial |
$39.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.71
|
|
|
BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES
|
Facility
IP
|
$61.34
|
|
|
Service Code
|
NDC 0904-6255-49
|
| Hospital Charge Code |
153363
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.94 |
| Max. Negotiated Rate |
$61.34 |
| Rate for Payer: Aetna Commercial |
$55.21
|
| Rate for Payer: ASR ASR |
$59.50
|
| Rate for Payer: BCBS Trust/PPO |
$47.56
|
| Rate for Payer: BCN Commercial |
$47.56
|
| Rate for Payer: Cash Price |
$49.07
|
| Rate for Payer: Cofinity Commercial |
$57.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.07
|
| Rate for Payer: Healthscope Commercial |
$61.34
|
| Rate for Payer: Healthscope Whirlpool |
$59.50
|
| Rate for Payer: Mclaren Commercial |
$55.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.98
|
|
|
BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY
|
Facility
IP
|
$100.09
|
|
|
Service Code
|
NDC 0283-0679-02
|
| Hospital Charge Code |
19696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.06 |
| Max. Negotiated Rate |
$100.09 |
| Rate for Payer: Aetna Commercial |
$90.08
|
| Rate for Payer: ASR ASR |
$97.09
|
| Rate for Payer: BCBS Trust/PPO |
$77.60
|
| Rate for Payer: BCN Commercial |
$77.60
|
| Rate for Payer: Cash Price |
$80.07
|
| Rate for Payer: Cofinity Commercial |
$94.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.07
|
| Rate for Payer: Healthscope Commercial |
$100.09
|
| Rate for Payer: Healthscope Whirlpool |
$97.09
|
| Rate for Payer: Mclaren Commercial |
$90.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.08
|
|
|
BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY
|
Facility
IP
|
$129.13
|
|
|
Service Code
|
NDC 0283-0679-60
|
| Hospital Charge Code |
19696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.39 |
| Max. Negotiated Rate |
$129.13 |
| Rate for Payer: Aetna Commercial |
$116.22
|
| Rate for Payer: ASR ASR |
$125.26
|
| Rate for Payer: BCBS Trust/PPO |
$100.11
|
| Rate for Payer: BCN Commercial |
$100.11
|
| Rate for Payer: Cash Price |
$103.31
|
| Rate for Payer: Cofinity Commercial |
$121.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.30
|
| Rate for Payer: Healthscope Commercial |
$129.13
|
| Rate for Payer: Healthscope Whirlpool |
$125.26
|
| Rate for Payer: Mclaren Commercial |
$116.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.63
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
IP
|
$3.52
|
|
|
Service Code
|
NDC 68084-214-11
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Aetna Commercial |
$3.17
|
| Rate for Payer: ASR ASR |
$3.41
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$3.52
|
| Rate for Payer: Healthscope Whirlpool |
$3.41
|
| Rate for Payer: Mclaren Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.10
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
IP
|
$351.50
|
|
|
Service Code
|
NDC 68084-214-01
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.05 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Aetna Commercial |
$316.35
|
| Rate for Payer: ASR ASR |
$340.96
|
| Rate for Payer: BCBS Trust/PPO |
$272.52
|
| Rate for Payer: BCN Commercial |
$272.52
|
| Rate for Payer: Cash Price |
$281.20
|
| Rate for Payer: Cofinity Commercial |
$330.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.20
|
| Rate for Payer: Healthscope Commercial |
$351.50
|
| Rate for Payer: Healthscope Whirlpool |
$340.96
|
| Rate for Payer: Mclaren Commercial |
$316.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.32
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
IP
|
$302.10
|
|
|
Service Code
|
NDC 0904-7153-61
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.47 |
| Max. Negotiated Rate |
$302.10 |
| Rate for Payer: Aetna Commercial |
$271.89
|
| Rate for Payer: ASR ASR |
$293.04
|
| Rate for Payer: BCBS Trust/PPO |
$234.22
|
| Rate for Payer: BCN Commercial |
$234.22
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$283.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Healthscope Commercial |
$302.10
|
| Rate for Payer: Healthscope Whirlpool |
$293.04
|
| Rate for Payer: Mclaren Commercial |
$271.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$256.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.85
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
IP
|
$872.16
|
|
|
Service Code
|
NDC 0069-0122-01
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$610.51 |
| Max. Negotiated Rate |
$872.16 |
| Rate for Payer: Aetna Commercial |
$784.94
|
| Rate for Payer: ASR ASR |
$846.00
|
| Rate for Payer: BCBS Trust/PPO |
$676.19
|
| Rate for Payer: BCN Commercial |
$676.19
|
| Rate for Payer: Cash Price |
$697.73
|
| Rate for Payer: Cofinity Commercial |
$819.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$697.73
|
| Rate for Payer: Healthscope Commercial |
$872.16
|
| Rate for Payer: Healthscope Whirlpool |
$846.00
|
| Rate for Payer: Mclaren Commercial |
$784.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$741.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$610.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$767.50
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
IP
|
$302.10
|
|
|
Service Code
|
NDC 0904-6564-61
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.47 |
| Max. Negotiated Rate |
$302.10 |
| Rate for Payer: Aetna Commercial |
$271.89
|
| Rate for Payer: ASR ASR |
$293.04
|
| Rate for Payer: BCBS Trust/PPO |
$234.22
|
| Rate for Payer: BCN Commercial |
$234.22
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$283.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Healthscope Commercial |
$302.10
|
| Rate for Payer: Healthscope Whirlpool |
$293.04
|
| Rate for Payer: Mclaren Commercial |
$271.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$256.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.85
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
IP
|
$425.35
|
|
|
Service Code
|
NDC 0904-6564-60
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.74 |
| Max. Negotiated Rate |
$425.35 |
| Rate for Payer: Cofinity Commercial |
$399.83
|
| Rate for Payer: Aetna Commercial |
$382.82
|
| Rate for Payer: ASR ASR |
$412.59
|
| Rate for Payer: BCBS Trust/PPO |
$329.77
|
| Rate for Payer: BCN Commercial |
$329.77
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Healthscope Commercial |
$425.35
|
| Rate for Payer: Healthscope Whirlpool |
$412.59
|
| Rate for Payer: Mclaren Commercial |
$382.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$361.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$374.31
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
IP
|
$287.85
|
|
|
Service Code
|
NDC 0904-6790-61
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$287.85 |
| Rate for Payer: Aetna Commercial |
$259.06
|
| Rate for Payer: ASR ASR |
$279.21
|
| Rate for Payer: BCBS Trust/PPO |
$223.17
|
| Rate for Payer: BCN Commercial |
$223.17
|
| Rate for Payer: Cash Price |
$230.28
|
| Rate for Payer: Cofinity Commercial |
$270.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.28
|
| Rate for Payer: Healthscope Commercial |
$287.85
|
| Rate for Payer: Healthscope Whirlpool |
$279.21
|
| Rate for Payer: Mclaren Commercial |
$259.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$244.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$253.31
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
IP
|
$242.05
|
|
|
Service Code
|
NDC 76385-104-01
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.44 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$217.84
|
| Rate for Payer: ASR ASR |
$234.79
|
| Rate for Payer: BCBS Trust/PPO |
$187.66
|
| Rate for Payer: BCN Commercial |
$187.66
|
| Rate for Payer: Cash Price |
$193.64
|
| Rate for Payer: Cofinity Commercial |
$227.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.64
|
| Rate for Payer: Healthscope Commercial |
$242.05
|
| Rate for Payer: Healthscope Whirlpool |
$234.79
|
| Rate for Payer: Mclaren Commercial |
$217.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.00
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
IP
|
$153.52
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.46 |
| Max. Negotiated Rate |
$153.52 |
| Rate for Payer: Aetna Commercial |
$138.17
|
| Rate for Payer: ASR ASR |
$148.91
|
| Rate for Payer: BCBS Trust/PPO |
$119.02
|
| Rate for Payer: BCN Commercial |
$119.02
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cofinity Commercial |
$144.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.82
|
| Rate for Payer: Healthscope Commercial |
$153.52
|
| Rate for Payer: Healthscope Whirlpool |
$148.91
|
| Rate for Payer: Mclaren Commercial |
$138.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.10
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC
|
Facility
IP
|
$87,549.54
|
|
|
Service Code
|
MS-DRG 461
|
| Min. Negotiated Rate |
$56,438.63 |
| Max. Negotiated Rate |
$87,549.54 |
| Rate for Payer: Aetna Medicare |
$59,409.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74,261.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74,261.35
|
| Rate for Payer: BCBS MAPPO |
$59,409.08
|
| Rate for Payer: BCN Medicare Advantage |
$59,409.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59,409.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$59,409.08
|
| Rate for Payer: Mclaren Medicare |
$59,409.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$62,379.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68,320.44
|
| Rate for Payer: PACE Medicare |
$56,438.63
|
| Rate for Payer: PACE SWMI |
$59,409.08
|
| Rate for Payer: PHP Commercial |
$65,349.99
|
| Rate for Payer: PHP Medicare Advantage |
$59,409.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87,549.54
|
| Rate for Payer: Priority Health Medicare |
$59,409.08
|
| Rate for Payer: Priority Health Narrow Network |
$70,039.63
|
| Rate for Payer: Railroad Medicare Medicare |
$59,409.08
|
| Rate for Payer: UHC Medicare Advantage |
$61,191.35
|
| Rate for Payer: VA VA |
$59,409.08
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC
|
Facility
IP
|
$36,546.49
|
|
|
Service Code
|
MS-DRG 462
|
| Min. Negotiated Rate |
$24,489.91 |
| Max. Negotiated Rate |
$36,546.49 |
| Rate for Payer: Aetna Medicare |
$25,778.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32,223.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32,223.56
|
| Rate for Payer: BCBS MAPPO |
$25,778.85
|
| Rate for Payer: BCN Medicare Advantage |
$25,778.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,778.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$25,778.85
|
| Rate for Payer: Mclaren Medicare |
$25,778.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27,067.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,645.68
|
| Rate for Payer: PACE Medicare |
$24,489.91
|
| Rate for Payer: PACE SWMI |
$25,778.85
|
| Rate for Payer: PHP Commercial |
$28,356.74
|
| Rate for Payer: PHP Medicare Advantage |
$25,778.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,546.49
|
| Rate for Payer: Priority Health Medicare |
$25,778.85
|
| Rate for Payer: Priority Health Narrow Network |
$29,237.19
|
| Rate for Payer: Railroad Medicare Medicare |
$25,778.85
|
| Rate for Payer: UHC Medicare Advantage |
$26,552.22
|
| Rate for Payer: VA VA |
$25,778.85
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC
|
Facility
IP
|
$25,131.73
|
|
|
Service Code
|
MS-DRG 409
|
| Min. Negotiated Rate |
$17,339.60 |
| Max. Negotiated Rate |
$25,131.73 |
| Rate for Payer: Aetna Medicare |
$18,252.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,815.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,815.26
|
| Rate for Payer: BCBS MAPPO |
$18,252.21
|
| Rate for Payer: BCN Medicare Advantage |
$18,252.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,252.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,252.21
|
| Rate for Payer: Mclaren Medicare |
$18,252.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,164.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,990.04
|
| Rate for Payer: PACE Medicare |
$17,339.60
|
| Rate for Payer: PACE SWMI |
$18,252.21
|
| Rate for Payer: PHP Commercial |
$20,077.43
|
| Rate for Payer: PHP Medicare Advantage |
$18,252.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,131.73
|
| Rate for Payer: Priority Health Medicare |
$18,252.21
|
| Rate for Payer: Priority Health Narrow Network |
$20,105.38
|
| Rate for Payer: Railroad Medicare Medicare |
$18,252.21
|
| Rate for Payer: UHC Medicare Advantage |
$18,799.78
|
| Rate for Payer: VA VA |
$18,252.21
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC
|
Facility
IP
|
$47,793.05
|
|
|
Service Code
|
MS-DRG 408
|
| Min. Negotiated Rate |
$31,534.83 |
| Max. Negotiated Rate |
$47,793.05 |
| Rate for Payer: Aetna Medicare |
$33,194.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41,493.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41,493.20
|
| Rate for Payer: BCBS MAPPO |
$33,194.56
|
| Rate for Payer: BCN Medicare Advantage |
$33,194.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33,194.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$33,194.56
|
| Rate for Payer: Mclaren Medicare |
$33,194.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34,854.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38,173.74
|
| Rate for Payer: PACE Medicare |
$31,534.83
|
| Rate for Payer: PACE SWMI |
$33,194.56
|
| Rate for Payer: PHP Commercial |
$36,514.02
|
| Rate for Payer: PHP Medicare Advantage |
$33,194.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47,793.05
|
| Rate for Payer: Priority Health Medicare |
$33,194.56
|
| Rate for Payer: Priority Health Narrow Network |
$38,234.44
|
| Rate for Payer: Railroad Medicare Medicare |
$33,194.56
|
| Rate for Payer: UHC Medicare Advantage |
$34,190.40
|
| Rate for Payer: VA VA |
$33,194.56
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
IP
|
$20,097.17
|
|
|
Service Code
|
MS-DRG 410
|
| Min. Negotiated Rate |
$14,185.91 |
| Max. Negotiated Rate |
$20,097.17 |
| Rate for Payer: Aetna Medicare |
$14,932.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,665.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,665.68
|
| Rate for Payer: BCBS MAPPO |
$14,932.54
|
| Rate for Payer: BCN Medicare Advantage |
$14,932.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,932.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,932.54
|
| Rate for Payer: Mclaren Medicare |
$14,932.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,679.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,172.42
|
| Rate for Payer: PACE Medicare |
$14,185.91
|
| Rate for Payer: PACE SWMI |
$14,932.54
|
| Rate for Payer: PHP Commercial |
$16,425.79
|
| Rate for Payer: PHP Medicare Advantage |
$14,932.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,097.17
|
| Rate for Payer: Priority Health Medicare |
$14,932.54
|
| Rate for Payer: Priority Health Narrow Network |
$16,077.74
|
| Rate for Payer: Railroad Medicare Medicare |
$14,932.54
|
| Rate for Payer: UHC Medicare Advantage |
$15,380.52
|
| Rate for Payer: VA VA |
$14,932.54
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
IP
|
$30,606.71
|
|
|
Service Code
|
MS-DRG 478
|
| Min. Negotiated Rate |
$20,769.18 |
| Max. Negotiated Rate |
$30,606.71 |
| Rate for Payer: Aetna Medicare |
$21,862.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,327.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,327.86
|
| Rate for Payer: BCBS MAPPO |
$21,862.29
|
| Rate for Payer: BCN Medicare Advantage |
$21,862.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,862.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$21,862.29
|
| Rate for Payer: Mclaren Medicare |
$21,862.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,955.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,141.63
|
| Rate for Payer: PACE Medicare |
$20,769.18
|
| Rate for Payer: PACE SWMI |
$21,862.29
|
| Rate for Payer: PHP Commercial |
$24,048.52
|
| Rate for Payer: PHP Medicare Advantage |
$21,862.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,606.71
|
| Rate for Payer: Priority Health Medicare |
$21,862.29
|
| Rate for Payer: Priority Health Narrow Network |
$24,485.37
|
| Rate for Payer: Railroad Medicare Medicare |
$21,862.29
|
| Rate for Payer: UHC Medicare Advantage |
$22,518.16
|
| Rate for Payer: VA VA |
$21,862.29
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
IP
|
$43,257.96
|
|
|
Service Code
|
MS-DRG 477
|
| Min. Negotiated Rate |
$28,694.00 |
| Max. Negotiated Rate |
$43,257.96 |
| Rate for Payer: Aetna Medicare |
$30,204.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37,755.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37,755.26
|
| Rate for Payer: BCBS MAPPO |
$30,204.21
|
| Rate for Payer: BCN Medicare Advantage |
$30,204.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,204.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$30,204.21
|
| Rate for Payer: Mclaren Medicare |
$30,204.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31,714.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,734.84
|
| Rate for Payer: PACE Medicare |
$28,694.00
|
| Rate for Payer: PACE SWMI |
$30,204.21
|
| Rate for Payer: PHP Commercial |
$33,224.63
|
| Rate for Payer: PHP Medicare Advantage |
$30,204.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43,257.96
|
| Rate for Payer: Priority Health Medicare |
$30,204.21
|
| Rate for Payer: Priority Health Narrow Network |
$34,606.37
|
| Rate for Payer: Railroad Medicare Medicare |
$30,204.21
|
| Rate for Payer: UHC Medicare Advantage |
$31,110.34
|
| Rate for Payer: VA VA |
$30,204.21
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
IP
|
$23,933.76
|
|
|
Service Code
|
MS-DRG 479
|
| Min. Negotiated Rate |
$16,589.18 |
| Max. Negotiated Rate |
$23,933.76 |
| Rate for Payer: Aetna Medicare |
$17,462.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,827.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,827.88
|
| Rate for Payer: BCBS MAPPO |
$17,462.30
|
| Rate for Payer: BCN Medicare Advantage |
$17,462.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,462.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,462.30
|
| Rate for Payer: Mclaren Medicare |
$17,462.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,335.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,081.64
|
| Rate for Payer: PACE Medicare |
$16,589.18
|
| Rate for Payer: PACE SWMI |
$17,462.30
|
| Rate for Payer: PHP Commercial |
$19,208.53
|
| Rate for Payer: PHP Medicare Advantage |
$17,462.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,933.76
|
| Rate for Payer: Priority Health Medicare |
$17,462.30
|
| Rate for Payer: Priority Health Narrow Network |
$19,147.01
|
| Rate for Payer: Railroad Medicare Medicare |
$17,462.30
|
| Rate for Payer: UHC Medicare Advantage |
$17,986.17
|
| Rate for Payer: VA VA |
$17,462.30
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$25.42
|
|
|
Service Code
|
NDC 0574-7050-12
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.79 |
| Max. Negotiated Rate |
$25.42 |
| Rate for Payer: Aetna Commercial |
$22.88
|
| Rate for Payer: ASR ASR |
$24.66
|
| Rate for Payer: BCBS Trust/PPO |
$19.71
|
| Rate for Payer: BCN Commercial |
$19.71
|
| Rate for Payer: Cash Price |
$20.34
|
| Rate for Payer: Cofinity Commercial |
$23.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.34
|
| Rate for Payer: Healthscope Commercial |
$25.42
|
| Rate for Payer: Healthscope Whirlpool |
$24.66
|
| Rate for Payer: Mclaren Commercial |
$22.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.37
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$58.82
|
|
|
Service Code
|
NDC 70000-0451-2
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.17 |
| Max. Negotiated Rate |
$58.82 |
| Rate for Payer: Aetna Commercial |
$52.94
|
| Rate for Payer: ASR ASR |
$57.06
|
| Rate for Payer: BCBS Trust/PPO |
$45.60
|
| Rate for Payer: BCN Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$47.06
|
| Rate for Payer: Cofinity Commercial |
$55.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.06
|
| Rate for Payer: Healthscope Commercial |
$58.82
|
| Rate for Payer: Healthscope Whirlpool |
$57.06
|
| Rate for Payer: Mclaren Commercial |
$52.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.76
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
IP
|
$5.88
|
|
|
Service Code
|
NDC 0904-6407-61
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$5.88 |
| Rate for Payer: Aetna Commercial |
$5.29
|
| Rate for Payer: ASR ASR |
$5.70
|
| Rate for Payer: BCBS Trust/PPO |
$4.56
|
| Rate for Payer: BCN Commercial |
$4.56
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cofinity Commercial |
$5.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.70
|
| Rate for Payer: Healthscope Commercial |
$5.88
|
| Rate for Payer: Healthscope Whirlpool |
$5.70
|
| Rate for Payer: Mclaren Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.17
|
|
