|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$4,033.17
|
|
|
Service Code
|
APR-DRG 2461
|
| Min. Negotiated Rate |
$3,646.47 |
| Max. Negotiated Rate |
$4,033.17 |
| Rate for Payer: BCBS Complete |
$4,033.17
|
| Rate for Payer: Mclaren Medicaid |
$3,841.12
|
| Rate for Payer: Meridian Medicaid |
$4,033.17
|
| Rate for Payer: PHP Medicaid |
$3,646.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,841.12
|
| Rate for Payer: UHC Medicaid |
$3,841.12
|
| Rate for Payer: UHCCP Medicaid |
$3,841.12
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$5,439.15
|
|
|
Service Code
|
APR-DRG 2462
|
| Min. Negotiated Rate |
$4,917.64 |
| Max. Negotiated Rate |
$5,439.15 |
| Rate for Payer: BCBS Complete |
$5,439.15
|
| Rate for Payer: Mclaren Medicaid |
$5,180.14
|
| Rate for Payer: Meridian Medicaid |
$5,439.15
|
| Rate for Payer: PHP Medicaid |
$4,917.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,180.14
|
| Rate for Payer: UHC Medicaid |
$5,180.14
|
| Rate for Payer: UHCCP Medicaid |
$5,180.14
|
|
|
GAUZE BANDAGE 1/2" X 5 YARD
|
Facility
|
OP
|
$13.10
|
|
|
Service Code
|
NDC 8080763200
|
| Hospital Charge Code |
111441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna Medicare |
$4.85
|
| Rate for Payer: ASR ASR |
$12.71
|
| Rate for Payer: BCBS Complete |
$5.24
|
| Rate for Payer: BCBS Trust/PPO |
$10.80
|
| Rate for Payer: BCN Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$10.48
|
| Rate for Payer: Cofinity Commercial |
$12.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.48
|
| Rate for Payer: Healthscope Commercial |
$12.71
|
| Rate for Payer: Healthscope Whirlpool |
$13.10
|
| Rate for Payer: Mclaren Commercial |
$11.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.13
|
| Rate for Payer: Nomi Health Commercial |
$10.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.48
|
| Rate for Payer: Priority Health Narrow Network |
$9.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.53
|
|
|
GAUZE BANDAGE 1/2" X 5 YARD
|
Facility
|
IP
|
$13.10
|
|
|
Service Code
|
NDC 8080763200
|
| Hospital Charge Code |
111441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: ASR ASR |
$12.71
|
| Rate for Payer: BCBS Trust/PPO |
$10.76
|
| Rate for Payer: BCN Commercial |
$10.76
|
| Rate for Payer: Cash Price |
$10.48
|
| Rate for Payer: Cofinity Commercial |
$12.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.48
|
| Rate for Payer: Healthscope Commercial |
$12.71
|
| Rate for Payer: Healthscope Whirlpool |
$13.10
|
| Rate for Payer: Mclaren Commercial |
$11.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.13
|
| Rate for Payer: Nomi Health Commercial |
$10.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.53
|
|
|
GAUZE BANDAGE 1/4" X 5 YARD
|
Facility
|
OP
|
$12.69
|
|
|
Service Code
|
NDC 8080763100
|
| Hospital Charge Code |
111543
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$12.69 |
| Rate for Payer: Aetna Commercial |
$11.42
|
| Rate for Payer: Aetna Medicare |
$4.70
|
| Rate for Payer: ASR ASR |
$12.31
|
| Rate for Payer: BCBS Complete |
$5.08
|
| Rate for Payer: BCBS Trust/PPO |
$10.46
|
| Rate for Payer: BCN Commercial |
$10.46
|
| Rate for Payer: Cash Price |
$10.15
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.15
|
| Rate for Payer: Healthscope Commercial |
$12.31
|
| Rate for Payer: Healthscope Whirlpool |
$12.69
|
| Rate for Payer: Mclaren Commercial |
$11.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.79
|
| Rate for Payer: Nomi Health Commercial |
$10.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.12
|
| Rate for Payer: Priority Health Narrow Network |
$8.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.17
|
|
|
GAUZE BANDAGE 1/4" X 5 YARD
|
Facility
|
IP
|
$12.69
|
|
|
Service Code
|
NDC 8080763100
|
| Hospital Charge Code |
111543
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$12.69 |
| Rate for Payer: Aetna Commercial |
$11.42
|
| Rate for Payer: ASR ASR |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$10.42
|
| Rate for Payer: BCN Commercial |
$10.42
|
| Rate for Payer: Cash Price |
$10.15
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.15
|
| Rate for Payer: Healthscope Commercial |
$12.31
|
| Rate for Payer: Healthscope Whirlpool |
$12.69
|
| Rate for Payer: Mclaren Commercial |
$11.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.79
|
| Rate for Payer: Nomi Health Commercial |
$10.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.17
|
|
|
GAUZE BANDAGE 1" X 5 YARD
|
Facility
|
OP
|
$14.87
|
|
|
Service Code
|
NDC 8080763300
|
| Hospital Charge Code |
111451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$14.87 |
| Rate for Payer: Aetna Commercial |
$13.39
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: ASR ASR |
$14.43
|
| Rate for Payer: BCBS Complete |
$5.95
|
| Rate for Payer: BCBS Trust/PPO |
$12.26
|
| Rate for Payer: BCN Commercial |
$12.26
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cofinity Commercial |
$13.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.90
|
| Rate for Payer: Healthscope Commercial |
$14.43
|
| Rate for Payer: Healthscope Whirlpool |
$14.87
|
| Rate for Payer: Mclaren Commercial |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.64
|
| Rate for Payer: Nomi Health Commercial |
$12.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.03
|
| Rate for Payer: Priority Health Narrow Network |
$10.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.09
|
|
|
GAUZE BANDAGE 1" X 5 YARD
|
Facility
|
IP
|
$14.87
|
|
|
Service Code
|
NDC 8080763300
|
| Hospital Charge Code |
111451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$14.87 |
| Rate for Payer: Aetna Commercial |
$13.39
|
| Rate for Payer: ASR ASR |
$14.43
|
| Rate for Payer: BCBS Trust/PPO |
$12.21
|
| Rate for Payer: BCN Commercial |
$12.21
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cofinity Commercial |
$13.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.90
|
| Rate for Payer: Healthscope Commercial |
$14.43
|
| Rate for Payer: Healthscope Whirlpool |
$14.87
|
| Rate for Payer: Mclaren Commercial |
$13.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.64
|
| Rate for Payer: Nomi Health Commercial |
$12.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.09
|
|
|
GAUZE BANDAGE 2" X 5 YARD
|
Facility
|
IP
|
$177.25
|
|
|
Service Code
|
NDC 8080223100
|
| Hospital Charge Code |
111461
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.93 |
| Max. Negotiated Rate |
$177.25 |
| Rate for Payer: Aetna Commercial |
$159.52
|
| Rate for Payer: ASR ASR |
$171.93
|
| Rate for Payer: BCBS Trust/PPO |
$145.55
|
| Rate for Payer: BCN Commercial |
$145.55
|
| Rate for Payer: Cash Price |
$141.80
|
| Rate for Payer: Cofinity Commercial |
$166.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.80
|
| Rate for Payer: Healthscope Commercial |
$171.93
|
| Rate for Payer: Healthscope Whirlpool |
$177.25
|
| Rate for Payer: Mclaren Commercial |
$159.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.66
|
| Rate for Payer: Nomi Health Commercial |
$145.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.98
|
|
|
GAUZE BANDAGE 2" X 5 YARD
|
Facility
|
OP
|
$177.25
|
|
|
Service Code
|
NDC 8080223100
|
| Hospital Charge Code |
111461
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.58 |
| Max. Negotiated Rate |
$177.25 |
| Rate for Payer: Aetna Commercial |
$159.52
|
| Rate for Payer: Aetna Medicare |
$65.58
|
| Rate for Payer: ASR ASR |
$171.93
|
| Rate for Payer: BCBS Complete |
$70.90
|
| Rate for Payer: BCBS Trust/PPO |
$146.14
|
| Rate for Payer: BCN Commercial |
$146.14
|
| Rate for Payer: Cash Price |
$141.80
|
| Rate for Payer: Cofinity Commercial |
$166.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.80
|
| Rate for Payer: Healthscope Commercial |
$171.93
|
| Rate for Payer: Healthscope Whirlpool |
$177.25
|
| Rate for Payer: Mclaren Commercial |
$159.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.66
|
| Rate for Payer: Nomi Health Commercial |
$145.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$155.30
|
| Rate for Payer: Priority Health Narrow Network |
$124.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.98
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE
|
Facility
|
OP
|
$971.54
|
|
|
Service Code
|
NDC 9034201
|
| Hospital Charge Code |
28025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$359.47 |
| Max. Negotiated Rate |
$971.54 |
| Rate for Payer: Aetna Commercial |
$874.39
|
| Rate for Payer: Aetna Medicare |
$359.47
|
| Rate for Payer: ASR ASR |
$942.39
|
| Rate for Payer: BCBS Complete |
$388.62
|
| Rate for Payer: BCBS Trust/PPO |
$801.03
|
| Rate for Payer: BCN Commercial |
$801.03
|
| Rate for Payer: Cash Price |
$777.23
|
| Rate for Payer: Cofinity Commercial |
$913.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.23
|
| Rate for Payer: Healthscope Commercial |
$942.39
|
| Rate for Payer: Healthscope Whirlpool |
$971.54
|
| Rate for Payer: Mclaren Commercial |
$874.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$777.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.81
|
| Rate for Payer: Nomi Health Commercial |
$796.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$728.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$851.26
|
| Rate for Payer: Priority Health Narrow Network |
$681.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$854.95
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE
|
Facility
|
IP
|
$971.54
|
|
|
Service Code
|
NDC 9034201
|
| Hospital Charge Code |
28025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$728.65 |
| Max. Negotiated Rate |
$971.54 |
| Rate for Payer: Aetna Commercial |
$874.39
|
| Rate for Payer: ASR ASR |
$942.39
|
| Rate for Payer: BCBS Trust/PPO |
$797.83
|
| Rate for Payer: BCN Commercial |
$797.83
|
| Rate for Payer: Cash Price |
$777.23
|
| Rate for Payer: Cofinity Commercial |
$913.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.23
|
| Rate for Payer: Healthscope Commercial |
$942.39
|
| Rate for Payer: Healthscope Whirlpool |
$971.54
|
| Rate for Payer: Mclaren Commercial |
$874.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.81
|
| Rate for Payer: Nomi Health Commercial |
$796.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$728.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$854.95
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE
|
Facility
|
OP
|
$407.42
|
|
|
Service Code
|
NDC 9031508
|
| Hospital Charge Code |
28018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$150.74 |
| Max. Negotiated Rate |
$407.42 |
| Rate for Payer: Aetna Commercial |
$366.67
|
| Rate for Payer: Aetna Medicare |
$150.74
|
| Rate for Payer: ASR ASR |
$395.19
|
| Rate for Payer: BCBS Complete |
$162.97
|
| Rate for Payer: BCBS Trust/PPO |
$335.91
|
| Rate for Payer: BCN Commercial |
$335.91
|
| Rate for Payer: Cash Price |
$325.93
|
| Rate for Payer: Cofinity Commercial |
$382.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.93
|
| Rate for Payer: Healthscope Commercial |
$395.19
|
| Rate for Payer: Healthscope Whirlpool |
$407.42
|
| Rate for Payer: Mclaren Commercial |
$366.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$325.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.30
|
| Rate for Payer: Nomi Health Commercial |
$334.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$305.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$356.98
|
| Rate for Payer: Priority Health Narrow Network |
$285.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$358.53
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE
|
Facility
|
IP
|
$407.42
|
|
|
Service Code
|
NDC 9031508
|
| Hospital Charge Code |
28018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$305.56 |
| Max. Negotiated Rate |
$407.42 |
| Rate for Payer: Aetna Commercial |
$366.67
|
| Rate for Payer: ASR ASR |
$395.19
|
| Rate for Payer: BCBS Trust/PPO |
$334.57
|
| Rate for Payer: BCN Commercial |
$334.57
|
| Rate for Payer: Cash Price |
$325.93
|
| Rate for Payer: Cofinity Commercial |
$382.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.93
|
| Rate for Payer: Healthscope Commercial |
$395.19
|
| Rate for Payer: Healthscope Whirlpool |
$407.42
|
| Rate for Payer: Mclaren Commercial |
$366.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.30
|
| Rate for Payer: Nomi Health Commercial |
$334.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$305.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$358.53
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE
|
Facility
|
OP
|
$289.89
|
|
|
Service Code
|
NDC 63713001972
|
| Hospital Charge Code |
28018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$107.26 |
| Max. Negotiated Rate |
$289.89 |
| Rate for Payer: Aetna Commercial |
$260.90
|
| Rate for Payer: Aetna Medicare |
$107.26
|
| Rate for Payer: ASR ASR |
$281.19
|
| Rate for Payer: BCBS Complete |
$115.96
|
| Rate for Payer: BCBS Trust/PPO |
$239.01
|
| Rate for Payer: BCN Commercial |
$239.01
|
| Rate for Payer: Cash Price |
$231.91
|
| Rate for Payer: Cofinity Commercial |
$272.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.91
|
| Rate for Payer: Healthscope Commercial |
$281.19
|
| Rate for Payer: Healthscope Whirlpool |
$289.89
|
| Rate for Payer: Mclaren Commercial |
$260.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.40
|
| Rate for Payer: Nomi Health Commercial |
$237.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$254.00
|
| Rate for Payer: Priority Health Narrow Network |
$203.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.10
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE
|
Facility
|
IP
|
$289.89
|
|
|
Service Code
|
NDC 63713001972
|
| Hospital Charge Code |
28018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$217.42 |
| Max. Negotiated Rate |
$289.89 |
| Rate for Payer: Aetna Commercial |
$260.90
|
| Rate for Payer: ASR ASR |
$281.19
|
| Rate for Payer: BCBS Trust/PPO |
$238.06
|
| Rate for Payer: BCN Commercial |
$238.06
|
| Rate for Payer: Cash Price |
$231.91
|
| Rate for Payer: Cofinity Commercial |
$272.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.91
|
| Rate for Payer: Healthscope Commercial |
$281.19
|
| Rate for Payer: Healthscope Whirlpool |
$289.89
|
| Rate for Payer: Mclaren Commercial |
$260.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.40
|
| Rate for Payer: Nomi Health Commercial |
$237.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.10
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
OP
|
$234.65
|
|
|
Service Code
|
NDC 60687022401
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.82 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Aetna Commercial |
$211.19
|
| Rate for Payer: Aetna Medicare |
$86.82
|
| Rate for Payer: ASR ASR |
$227.61
|
| Rate for Payer: BCBS Complete |
$93.86
|
| Rate for Payer: BCBS Trust/PPO |
$193.47
|
| Rate for Payer: BCN Commercial |
$193.47
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Commercial |
$220.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$227.61
|
| Rate for Payer: Healthscope Whirlpool |
$234.65
|
| Rate for Payer: Mclaren Commercial |
$211.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Nomi Health Commercial |
$192.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$205.60
|
| Rate for Payer: Priority Health Narrow Network |
$164.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.49
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
IP
|
$2.35
|
|
|
Service Code
|
NDC 60687022411
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna Commercial |
$2.11
|
| Rate for Payer: ASR ASR |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$1.93
|
| Rate for Payer: BCN Commercial |
$1.93
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$2.28
|
| Rate for Payer: Healthscope Whirlpool |
$2.35
|
| Rate for Payer: Mclaren Commercial |
$2.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.99
|
| Rate for Payer: Nomi Health Commercial |
$1.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.07
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
IP
|
$234.65
|
|
|
Service Code
|
NDC 60687022401
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.99 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Aetna Commercial |
$211.19
|
| Rate for Payer: ASR ASR |
$227.61
|
| Rate for Payer: BCBS Trust/PPO |
$192.69
|
| Rate for Payer: BCN Commercial |
$192.69
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Commercial |
$220.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$227.61
|
| Rate for Payer: Healthscope Whirlpool |
$234.65
|
| Rate for Payer: Mclaren Commercial |
$211.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Nomi Health Commercial |
$192.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.49
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
OP
|
$2.35
|
|
|
Service Code
|
NDC 60687022411
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna Commercial |
$2.11
|
| Rate for Payer: Aetna Medicare |
$0.87
|
| Rate for Payer: ASR ASR |
$2.28
|
| Rate for Payer: BCBS Complete |
$0.94
|
| Rate for Payer: BCBS Trust/PPO |
$1.94
|
| Rate for Payer: BCN Commercial |
$1.94
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$2.28
|
| Rate for Payer: Healthscope Whirlpool |
$2.35
|
| Rate for Payer: Mclaren Commercial |
$2.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.99
|
| Rate for Payer: Nomi Health Commercial |
$1.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.06
|
| Rate for Payer: Priority Health Narrow Network |
$1.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.07
|
|
|
GENDER RELATED PROCEDURES
|
Facility
|
IP
|
$52,967.51
|
|
|
Service Code
|
APR-DRG 8513
|
| Min. Negotiated Rate |
$47,888.96 |
| Max. Negotiated Rate |
$52,967.51 |
| Rate for Payer: BCBS Complete |
$52,967.51
|
| Rate for Payer: Mclaren Medicaid |
$50,445.24
|
| Rate for Payer: Meridian Medicaid |
$52,967.51
|
| Rate for Payer: PHP Medicaid |
$47,888.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$50,445.24
|
| Rate for Payer: UHC Medicaid |
$50,445.24
|
| Rate for Payer: UHCCP Medicaid |
$50,445.24
|
|
|
GENDER RELATED PROCEDURES
|
Facility
|
IP
|
$13,837.37
|
|
|
Service Code
|
APR-DRG 8512
|
| Min. Negotiated Rate |
$12,510.64 |
| Max. Negotiated Rate |
$13,837.37 |
| Rate for Payer: BCBS Complete |
$13,837.37
|
| Rate for Payer: Mclaren Medicaid |
$13,178.45
|
| Rate for Payer: Meridian Medicaid |
$13,837.37
|
| Rate for Payer: PHP Medicaid |
$12,510.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,178.45
|
| Rate for Payer: UHC Medicaid |
$13,178.45
|
| Rate for Payer: UHCCP Medicaid |
$13,178.45
|
|
|
GENDER RELATED PROCEDURES
|
Facility
|
IP
|
$9,591.66
|
|
|
Service Code
|
APR-DRG 8511
|
| Min. Negotiated Rate |
$8,672.01 |
| Max. Negotiated Rate |
$9,591.66 |
| Rate for Payer: BCBS Complete |
$9,591.66
|
| Rate for Payer: Mclaren Medicaid |
$9,134.92
|
| Rate for Payer: Meridian Medicaid |
$9,591.66
|
| Rate for Payer: PHP Medicaid |
$8,672.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,134.92
|
| Rate for Payer: UHC Medicaid |
$9,134.92
|
| Rate for Payer: UHCCP Medicaid |
$9,134.92
|
|
|
GENDER RELATED PROCEDURES
|
Facility
|
IP
|
$52,967.51
|
|
|
Service Code
|
APR-DRG 8514
|
| Min. Negotiated Rate |
$47,888.96 |
| Max. Negotiated Rate |
$52,967.51 |
| Rate for Payer: BCBS Complete |
$52,967.51
|
| Rate for Payer: Mclaren Medicaid |
$50,445.24
|
| Rate for Payer: Meridian Medicaid |
$52,967.51
|
| Rate for Payer: PHP Medicaid |
$47,888.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$50,445.24
|
| Rate for Payer: UHC Medicaid |
$50,445.24
|
| Rate for Payer: UHCCP Medicaid |
$50,445.24
|
|
|
GENETIC DISORDERS
|
Facility
|
IP
|
$23,727.67
|
|
|
Service Code
|
APR-DRG 4284
|
| Min. Negotiated Rate |
$21,452.65 |
| Max. Negotiated Rate |
$23,727.67 |
| Rate for Payer: BCBS Complete |
$23,727.67
|
| Rate for Payer: Mclaren Medicaid |
$22,597.78
|
| Rate for Payer: Meridian Medicaid |
$23,727.67
|
| Rate for Payer: PHP Medicaid |
$21,452.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,597.78
|
| Rate for Payer: UHC Medicaid |
$22,597.78
|
| Rate for Payer: UHCCP Medicaid |
$22,597.78
|
|
