|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$5,902.35
|
|
|
Service Code
|
APR-DRG 2341
|
| Min. Negotiated Rate |
$5,336.43 |
| Max. Negotiated Rate |
$5,902.35 |
| Rate for Payer: BCBS Complete |
$5,902.35
|
| Rate for Payer: Mclaren Medicaid |
$5,621.29
|
| Rate for Payer: Meridian Medicaid |
$5,902.35
|
| Rate for Payer: PHP Medicaid |
$5,336.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,621.29
|
| Rate for Payer: UHC Medicaid |
$5,621.29
|
| Rate for Payer: UHCCP Medicaid |
$5,621.29
|
|
|
APPENDIX PROCEDURES WITH CC
|
Facility
|
IP
|
$20,795.05
|
|
|
Service Code
|
MSDRG 398
|
| Min. Negotiated Rate |
$12,021.55 |
| Max. Negotiated Rate |
$20,795.05 |
| Rate for Payer: Aetna Medicare |
$12,654.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,817.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,817.83
|
| Rate for Payer: BCBS MAPPO |
$12,654.26
|
| Rate for Payer: BCN Medicare Advantage |
$12,654.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,654.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,654.26
|
| Rate for Payer: Mclaren Medicare |
$12,654.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,286.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,552.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,919.69
|
| Rate for Payer: PACE Medicare |
$12,021.55
|
| Rate for Payer: PACE SWMI |
$12,654.26
|
| Rate for Payer: PHP Commercial |
$13,919.69
|
| Rate for Payer: PHP Medicare Advantage |
$12,654.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20,795.05
|
| Rate for Payer: Priority Health Medicare |
$12,654.26
|
| Rate for Payer: Priority Health Narrow Network |
$16,636.04
|
| Rate for Payer: Railroad Medicare Medicare |
$12,654.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,654.26
|
| Rate for Payer: UHC Exchange |
$19,614.10
|
| Rate for Payer: UHCCP DNSP |
$12,654.26
|
| Rate for Payer: VA VA |
$12,654.26
|
|
|
APPENDIX PROCEDURES WITH MCC
|
Facility
|
IP
|
$32,903.05
|
|
|
Service Code
|
MSDRG 397
|
| Min. Negotiated Rate |
$18,050.68 |
| Max. Negotiated Rate |
$32,903.05 |
| Rate for Payer: Aetna Medicare |
$19,000.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,750.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,750.90
|
| Rate for Payer: BCBS MAPPO |
$19,000.72
|
| Rate for Payer: BCN Medicare Advantage |
$19,000.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,000.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$19,000.72
|
| Rate for Payer: Mclaren Medicare |
$19,000.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,950.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,850.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,900.79
|
| Rate for Payer: PACE Medicare |
$18,050.68
|
| Rate for Payer: PACE SWMI |
$19,000.72
|
| Rate for Payer: PHP Commercial |
$20,900.79
|
| Rate for Payer: PHP Medicare Advantage |
$19,000.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$32,903.05
|
| Rate for Payer: Priority Health Medicare |
$19,000.72
|
| Rate for Payer: Priority Health Narrow Network |
$26,322.44
|
| Rate for Payer: Railroad Medicare Medicare |
$19,000.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,000.72
|
| Rate for Payer: UHC Exchange |
$29,451.12
|
| Rate for Payer: UHCCP DNSP |
$19,000.72
|
| Rate for Payer: VA VA |
$19,000.72
|
|
|
APPENDIX PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$15,726.80
|
|
|
Service Code
|
MSDRG 399
|
| Min. Negotiated Rate |
$9,497.83 |
| Max. Negotiated Rate |
$15,726.80 |
| Rate for Payer: Aetna Medicare |
$9,997.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,497.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,497.15
|
| Rate for Payer: BCBS MAPPO |
$9,997.72
|
| Rate for Payer: BCN Medicare Advantage |
$9,997.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,997.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,997.72
|
| Rate for Payer: Mclaren Medicare |
$9,997.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,497.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,497.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,997.49
|
| Rate for Payer: PACE Medicare |
$9,497.83
|
| Rate for Payer: PACE SWMI |
$9,997.72
|
| Rate for Payer: PHP Commercial |
$10,997.49
|
| Rate for Payer: PHP Medicare Advantage |
$9,997.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15,726.80
|
| Rate for Payer: Priority Health Medicare |
$9,997.72
|
| Rate for Payer: Priority Health Narrow Network |
$12,581.44
|
| Rate for Payer: Railroad Medicare Medicare |
$9,997.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,997.72
|
| Rate for Payer: UHC Exchange |
$15,496.47
|
| Rate for Payer: UHCCP DNSP |
$9,997.72
|
| Rate for Payer: VA VA |
$9,997.72
|
|
|
APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT)
|
Facility
|
OP
|
$250.98
|
|
|
Service Code
|
CPT 29515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$84.68 |
| Max. Negotiated Rate |
$250.98 |
| Rate for Payer: Aetna Medicare |
$161.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.40
|
| Rate for Payer: BCBS Complete |
$88.93
|
| Rate for Payer: BCBS MAPPO |
$161.92
|
| Rate for Payer: BCN Medicare Advantage |
$161.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$161.92
|
| Rate for Payer: Mclaren Medicaid |
$161.92
|
| Rate for Payer: Mclaren Medicare |
$161.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.02
|
| Rate for Payer: Meridian Medicaid |
$88.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$178.11
|
| Rate for Payer: PACE Medicare |
$153.82
|
| Rate for Payer: PACE SWMI |
$161.92
|
| Rate for Payer: PHP Commercial |
$178.11
|
| Rate for Payer: PHP Medicaid |
$86.79
|
| Rate for Payer: PHP Medicare Advantage |
$161.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$189.42
|
| Rate for Payer: Priority Health Medicare |
$161.92
|
| Rate for Payer: Priority Health Narrow Network |
$151.54
|
| Rate for Payer: Railroad Medicare Medicare |
$161.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.92
|
| Rate for Payer: UHC Exchange |
$250.98
|
| Rate for Payer: UHC Medicaid |
$84.68
|
| Rate for Payer: UHCCP DNSP |
$161.92
|
| Rate for Payer: UHCCP Medicaid |
$84.68
|
| Rate for Payer: VA VA |
$161.92
|
|
|
ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$396.18
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
28947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$396.18 |
| Rate for Payer: Aetna Commercial |
$356.56
|
| Rate for Payer: Aetna Commercial |
$404.97
|
| Rate for Payer: Aetna Medicare |
$1.01
|
| Rate for Payer: Aetna Medicare |
$1.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.26
|
| Rate for Payer: ASR ASR |
$384.29
|
| Rate for Payer: ASR ASR |
$436.46
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS MAPPO |
$1.01
|
| Rate for Payer: BCBS MAPPO |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$370.99
|
| Rate for Payer: BCBS Trust/PPO |
$326.65
|
| Rate for Payer: BCN Commercial |
$370.99
|
| Rate for Payer: BCN Commercial |
$326.65
|
| Rate for Payer: BCN Medicare Advantage |
$1.01
|
| Rate for Payer: BCN Medicare Advantage |
$1.01
|
| Rate for Payer: Cash Price |
$316.94
|
| Rate for Payer: Cash Price |
$316.94
|
| Rate for Payer: Cash Price |
$359.97
|
| Rate for Payer: Cash Price |
$359.97
|
| Rate for Payer: Cofinity Commercial |
$372.41
|
| Rate for Payer: Cofinity Commercial |
$422.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.01
|
| Rate for Payer: Healthscope Commercial |
$384.29
|
| Rate for Payer: Healthscope Commercial |
$436.46
|
| Rate for Payer: Healthscope Whirlpool |
$396.18
|
| Rate for Payer: Healthscope Whirlpool |
$449.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$1.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$1.01
|
| Rate for Payer: Mclaren Commercial |
$404.97
|
| Rate for Payer: Mclaren Commercial |
$356.56
|
| Rate for Payer: Mclaren Medicaid |
$1.01
|
| Rate for Payer: Mclaren Medicaid |
$1.01
|
| Rate for Payer: Mclaren Medicare |
$1.01
|
| Rate for Payer: Mclaren Medicare |
$1.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.06
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.47
|
| Rate for Payer: Nomi Health Commercial |
$368.97
|
| Rate for Payer: Nomi Health Commercial |
$324.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.47
|
| Rate for Payer: PACE Medicare |
$0.96
|
| Rate for Payer: PACE Medicare |
$0.96
|
| Rate for Payer: PACE SWMI |
$1.01
|
| Rate for Payer: PACE SWMI |
$1.01
|
| Rate for Payer: PHP Commercial |
$1.11
|
| Rate for Payer: PHP Commercial |
$1.11
|
| Rate for Payer: PHP Medicaid |
$0.54
|
| Rate for Payer: PHP Medicaid |
$0.54
|
| Rate for Payer: PHP Medicare Advantage |
$1.01
|
| Rate for Payer: PHP Medicare Advantage |
$1.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.63
|
| Rate for Payer: Priority Health Medicare |
$1.01
|
| Rate for Payer: Priority Health Medicare |
$1.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.50
|
| Rate for Payer: Priority Health Narrow Network |
$0.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$395.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.01
|
| Rate for Payer: UHC Exchange |
$1.57
|
| Rate for Payer: UHC Exchange |
$1.57
|
| Rate for Payer: UHC Medicaid |
$0.53
|
| Rate for Payer: UHC Medicaid |
$0.53
|
| Rate for Payer: UHCCP DNSP |
$1.01
|
| Rate for Payer: UHCCP DNSP |
$1.01
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: VA VA |
$1.01
|
| Rate for Payer: VA VA |
$1.01
|
|
|
ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$396.18
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
28947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$297.13 |
| Max. Negotiated Rate |
$396.18 |
| Rate for Payer: Aetna Commercial |
$356.56
|
| Rate for Payer: Aetna Commercial |
$404.97
|
| Rate for Payer: ASR ASR |
$384.29
|
| Rate for Payer: ASR ASR |
$436.46
|
| Rate for Payer: BCBS Trust/PPO |
$325.34
|
| Rate for Payer: BCBS Trust/PPO |
$369.51
|
| Rate for Payer: BCN Commercial |
$325.34
|
| Rate for Payer: BCN Commercial |
$369.51
|
| Rate for Payer: Cash Price |
$359.97
|
| Rate for Payer: Cash Price |
$316.94
|
| Rate for Payer: Cofinity Commercial |
$422.97
|
| Rate for Payer: Cofinity Commercial |
$372.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.97
|
| Rate for Payer: Healthscope Commercial |
$384.29
|
| Rate for Payer: Healthscope Commercial |
$436.46
|
| Rate for Payer: Healthscope Whirlpool |
$449.96
|
| Rate for Payer: Healthscope Whirlpool |
$396.18
|
| Rate for Payer: Mclaren Commercial |
$404.97
|
| Rate for Payer: Mclaren Commercial |
$356.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.75
|
| Rate for Payer: Nomi Health Commercial |
$368.97
|
| Rate for Payer: Nomi Health Commercial |
$324.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$395.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.64
|
|
|
ARGATROBAN 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$227.36
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
152708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.52 |
| Max. Negotiated Rate |
$227.36 |
| Rate for Payer: Aetna Commercial |
$204.62
|
| Rate for Payer: ASR ASR |
$220.54
|
| Rate for Payer: BCBS Trust/PPO |
$186.71
|
| Rate for Payer: BCN Commercial |
$186.71
|
| Rate for Payer: Cash Price |
$181.89
|
| Rate for Payer: Cofinity Commercial |
$213.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.89
|
| Rate for Payer: Healthscope Commercial |
$220.54
|
| Rate for Payer: Healthscope Whirlpool |
$227.36
|
| Rate for Payer: Mclaren Commercial |
$204.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.26
|
| Rate for Payer: Nomi Health Commercial |
$186.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.08
|
|
|
ARGATROBAN 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$227.36
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
152708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$227.36 |
| Rate for Payer: Aetna Commercial |
$204.62
|
| Rate for Payer: Aetna Medicare |
$1.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.26
|
| Rate for Payer: ASR ASR |
$220.54
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS MAPPO |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$187.46
|
| Rate for Payer: BCN Commercial |
$187.46
|
| Rate for Payer: BCN Medicare Advantage |
$1.01
|
| Rate for Payer: Cash Price |
$181.89
|
| Rate for Payer: Cash Price |
$181.89
|
| Rate for Payer: Cofinity Commercial |
$213.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.01
|
| Rate for Payer: Healthscope Commercial |
$220.54
|
| Rate for Payer: Healthscope Whirlpool |
$227.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$1.01
|
| Rate for Payer: Mclaren Commercial |
$204.62
|
| Rate for Payer: Mclaren Medicaid |
$1.01
|
| Rate for Payer: Mclaren Medicare |
$1.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.06
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.26
|
| Rate for Payer: Nomi Health Commercial |
$186.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.52
|
| Rate for Payer: PACE Medicare |
$0.96
|
| Rate for Payer: PACE SWMI |
$1.01
|
| Rate for Payer: PHP Commercial |
$1.11
|
| Rate for Payer: PHP Medicaid |
$0.54
|
| Rate for Payer: PHP Medicare Advantage |
$1.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.63
|
| Rate for Payer: Priority Health Medicare |
$1.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.01
|
| Rate for Payer: UHC Exchange |
$1.57
|
| Rate for Payer: UHC Medicaid |
$0.53
|
| Rate for Payer: UHCCP DNSP |
$1.01
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: VA VA |
$1.01
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
IP
|
$5.53
|
|
|
Service Code
|
NDC 50268009011
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$5.53 |
| Rate for Payer: Aetna Commercial |
$4.98
|
| Rate for Payer: ASR ASR |
$5.36
|
| Rate for Payer: BCBS Trust/PPO |
$4.54
|
| Rate for Payer: BCN Commercial |
$4.54
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cofinity Commercial |
$5.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.42
|
| Rate for Payer: Healthscope Commercial |
$5.36
|
| Rate for Payer: Healthscope Whirlpool |
$5.53
|
| Rate for Payer: Mclaren Commercial |
$4.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.70
|
| Rate for Payer: Nomi Health Commercial |
$4.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.87
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
OP
|
$57.57
|
|
|
Service Code
|
NDC 65162089903
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$57.57 |
| Rate for Payer: Aetna Commercial |
$51.81
|
| Rate for Payer: Aetna Medicare |
$21.30
|
| Rate for Payer: ASR ASR |
$55.84
|
| Rate for Payer: BCBS Complete |
$23.03
|
| Rate for Payer: BCBS Trust/PPO |
$47.47
|
| Rate for Payer: BCN Commercial |
$47.47
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$54.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.06
|
| Rate for Payer: Healthscope Commercial |
$55.84
|
| Rate for Payer: Healthscope Whirlpool |
$57.57
|
| Rate for Payer: Mclaren Commercial |
$51.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: Nomi Health Commercial |
$47.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$50.44
|
| Rate for Payer: Priority Health Narrow Network |
$40.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.66
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
IP
|
$57.57
|
|
|
Service Code
|
NDC 65162089903
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.18 |
| Max. Negotiated Rate |
$57.57 |
| Rate for Payer: Aetna Commercial |
$51.81
|
| Rate for Payer: ASR ASR |
$55.84
|
| Rate for Payer: BCBS Trust/PPO |
$47.28
|
| Rate for Payer: BCN Commercial |
$47.28
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$54.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.06
|
| Rate for Payer: Healthscope Commercial |
$55.84
|
| Rate for Payer: Healthscope Whirlpool |
$57.57
|
| Rate for Payer: Mclaren Commercial |
$51.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: Nomi Health Commercial |
$47.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.66
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
IP
|
$110.59
|
|
|
Service Code
|
NDC 50268009012
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.94 |
| Max. Negotiated Rate |
$110.59 |
| Rate for Payer: Aetna Commercial |
$99.53
|
| Rate for Payer: ASR ASR |
$107.27
|
| Rate for Payer: BCBS Trust/PPO |
$90.82
|
| Rate for Payer: BCN Commercial |
$90.82
|
| Rate for Payer: Cash Price |
$88.47
|
| Rate for Payer: Cofinity Commercial |
$103.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.47
|
| Rate for Payer: Healthscope Commercial |
$107.27
|
| Rate for Payer: Healthscope Whirlpool |
$110.59
|
| Rate for Payer: Mclaren Commercial |
$99.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.00
|
| Rate for Payer: Nomi Health Commercial |
$90.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.32
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
OP
|
$5.53
|
|
|
Service Code
|
NDC 50268009011
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$5.53 |
| Rate for Payer: Aetna Commercial |
$4.98
|
| Rate for Payer: Aetna Medicare |
$2.05
|
| Rate for Payer: ASR ASR |
$5.36
|
| Rate for Payer: BCBS Complete |
$2.21
|
| Rate for Payer: BCBS Trust/PPO |
$4.56
|
| Rate for Payer: BCN Commercial |
$4.56
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cofinity Commercial |
$5.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.42
|
| Rate for Payer: Healthscope Commercial |
$5.36
|
| Rate for Payer: Healthscope Whirlpool |
$5.53
|
| Rate for Payer: Mclaren Commercial |
$4.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.70
|
| Rate for Payer: Nomi Health Commercial |
$4.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.85
|
| Rate for Payer: Priority Health Narrow Network |
$3.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.87
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
OP
|
$110.59
|
|
|
Service Code
|
NDC 50268009012
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.92 |
| Max. Negotiated Rate |
$110.59 |
| Rate for Payer: Aetna Commercial |
$99.53
|
| Rate for Payer: Aetna Medicare |
$40.92
|
| Rate for Payer: ASR ASR |
$107.27
|
| Rate for Payer: BCBS Complete |
$44.24
|
| Rate for Payer: BCBS Trust/PPO |
$91.18
|
| Rate for Payer: BCN Commercial |
$91.18
|
| Rate for Payer: Cash Price |
$88.47
|
| Rate for Payer: Cofinity Commercial |
$103.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.47
|
| Rate for Payer: Healthscope Commercial |
$107.27
|
| Rate for Payer: Healthscope Whirlpool |
$110.59
|
| Rate for Payer: Mclaren Commercial |
$99.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.00
|
| Rate for Payer: Nomi Health Commercial |
$90.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$96.90
|
| Rate for Payer: Priority Health Narrow Network |
$77.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.32
|
|
|
ARIPIPRAZOLE 20 MG TABLET
|
Facility
|
IP
|
$72.96
|
|
|
Service Code
|
NDC 65162090103
|
| Hospital Charge Code |
34371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.72 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$65.66
|
| Rate for Payer: ASR ASR |
$70.77
|
| Rate for Payer: BCBS Trust/PPO |
$59.91
|
| Rate for Payer: BCN Commercial |
$59.91
|
| Rate for Payer: Cash Price |
$58.37
|
| Rate for Payer: Cofinity Commercial |
$68.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.37
|
| Rate for Payer: Healthscope Commercial |
$70.77
|
| Rate for Payer: Healthscope Whirlpool |
$72.96
|
| Rate for Payer: Mclaren Commercial |
$65.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.02
|
| Rate for Payer: Nomi Health Commercial |
$59.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.20
|
|
|
ARIPIPRAZOLE 20 MG TABLET
|
Facility
|
OP
|
$72.96
|
|
|
Service Code
|
NDC 65162090103
|
| Hospital Charge Code |
34371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$65.66
|
| Rate for Payer: Aetna Medicare |
$27.00
|
| Rate for Payer: ASR ASR |
$70.77
|
| Rate for Payer: BCBS Complete |
$29.18
|
| Rate for Payer: BCBS Trust/PPO |
$60.16
|
| Rate for Payer: BCN Commercial |
$60.16
|
| Rate for Payer: Cash Price |
$58.37
|
| Rate for Payer: Cofinity Commercial |
$68.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.37
|
| Rate for Payer: Healthscope Commercial |
$70.77
|
| Rate for Payer: Healthscope Whirlpool |
$72.96
|
| Rate for Payer: Mclaren Commercial |
$65.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.02
|
| Rate for Payer: Nomi Health Commercial |
$59.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$63.93
|
| Rate for Payer: Priority Health Narrow Network |
$51.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.20
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
OP
|
$57.57
|
|
|
Service Code
|
NDC 65162089603
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$57.57 |
| Rate for Payer: Aetna Commercial |
$51.81
|
| Rate for Payer: Aetna Medicare |
$21.30
|
| Rate for Payer: ASR ASR |
$55.84
|
| Rate for Payer: BCBS Complete |
$23.03
|
| Rate for Payer: BCBS Trust/PPO |
$47.47
|
| Rate for Payer: BCN Commercial |
$47.47
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$54.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.06
|
| Rate for Payer: Healthscope Commercial |
$55.84
|
| Rate for Payer: Healthscope Whirlpool |
$57.57
|
| Rate for Payer: Mclaren Commercial |
$51.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: Nomi Health Commercial |
$47.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$50.44
|
| Rate for Payer: Priority Health Narrow Network |
$40.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.66
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
IP
|
$57.57
|
|
|
Service Code
|
NDC 65162089603
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.18 |
| Max. Negotiated Rate |
$57.57 |
| Rate for Payer: Aetna Commercial |
$51.81
|
| Rate for Payer: ASR ASR |
$55.84
|
| Rate for Payer: BCBS Trust/PPO |
$47.28
|
| Rate for Payer: BCN Commercial |
$47.28
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$54.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.06
|
| Rate for Payer: Healthscope Commercial |
$55.84
|
| Rate for Payer: Healthscope Whirlpool |
$57.57
|
| Rate for Payer: Mclaren Commercial |
$51.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: Nomi Health Commercial |
$47.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.66
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
OP
|
$395.51
|
|
|
Service Code
|
NDC 65162089609
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.34 |
| Max. Negotiated Rate |
$395.50 |
| Rate for Payer: Aetna Commercial |
$355.95
|
| Rate for Payer: Aetna Medicare |
$146.34
|
| Rate for Payer: ASR ASR |
$383.64
|
| Rate for Payer: BCBS Complete |
$158.20
|
| Rate for Payer: BCBS Trust/PPO |
$326.09
|
| Rate for Payer: BCN Commercial |
$326.09
|
| Rate for Payer: Cash Price |
$316.40
|
| Rate for Payer: Cofinity Commercial |
$371.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.40
|
| Rate for Payer: Healthscope Commercial |
$383.64
|
| Rate for Payer: Healthscope Whirlpool |
$395.50
|
| Rate for Payer: Mclaren Commercial |
$355.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.18
|
| Rate for Payer: Nomi Health Commercial |
$324.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$346.54
|
| Rate for Payer: Priority Health Narrow Network |
$277.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.04
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
IP
|
$395.51
|
|
|
Service Code
|
NDC 65162089609
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$296.63 |
| Max. Negotiated Rate |
$395.50 |
| Rate for Payer: Aetna Commercial |
$355.95
|
| Rate for Payer: ASR ASR |
$383.64
|
| Rate for Payer: BCBS Trust/PPO |
$324.79
|
| Rate for Payer: BCN Commercial |
$324.79
|
| Rate for Payer: Cash Price |
$316.40
|
| Rate for Payer: Cofinity Commercial |
$371.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.40
|
| Rate for Payer: Healthscope Commercial |
$383.64
|
| Rate for Payer: Healthscope Whirlpool |
$395.50
|
| Rate for Payer: Mclaren Commercial |
$355.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.18
|
| Rate for Payer: Nomi Health Commercial |
$324.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.04
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
OP
|
$76.10
|
|
|
Service Code
|
NDC 65162089703
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.16 |
| Max. Negotiated Rate |
$76.09 |
| Rate for Payer: Aetna Commercial |
$68.49
|
| Rate for Payer: Aetna Medicare |
$28.16
|
| Rate for Payer: ASR ASR |
$73.81
|
| Rate for Payer: BCBS Complete |
$30.44
|
| Rate for Payer: BCBS Trust/PPO |
$62.74
|
| Rate for Payer: BCN Commercial |
$62.74
|
| Rate for Payer: Cash Price |
$60.88
|
| Rate for Payer: Cofinity Commercial |
$71.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.88
|
| Rate for Payer: Healthscope Commercial |
$73.81
|
| Rate for Payer: Healthscope Whirlpool |
$76.09
|
| Rate for Payer: Mclaren Commercial |
$68.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.68
|
| Rate for Payer: Nomi Health Commercial |
$62.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$66.67
|
| Rate for Payer: Priority Health Narrow Network |
$53.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.96
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
IP
|
$76.10
|
|
|
Service Code
|
NDC 65162089703
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.07 |
| Max. Negotiated Rate |
$76.09 |
| Rate for Payer: Aetna Commercial |
$68.49
|
| Rate for Payer: ASR ASR |
$73.81
|
| Rate for Payer: BCBS Trust/PPO |
$62.49
|
| Rate for Payer: BCN Commercial |
$62.49
|
| Rate for Payer: Cash Price |
$60.88
|
| Rate for Payer: Cofinity Commercial |
$71.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.88
|
| Rate for Payer: Healthscope Commercial |
$73.81
|
| Rate for Payer: Healthscope Whirlpool |
$76.09
|
| Rate for Payer: Mclaren Commercial |
$68.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.68
|
| Rate for Payer: Nomi Health Commercial |
$62.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.96
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
|
IP
|
$25.38
|
|
|
Service Code
|
NDC 57896018105
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna Commercial |
$22.84
|
| Rate for Payer: ASR ASR |
$24.62
|
| Rate for Payer: BCBS Trust/PPO |
$20.84
|
| Rate for Payer: BCN Commercial |
$20.84
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cofinity Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.30
|
| Rate for Payer: Healthscope Commercial |
$24.62
|
| Rate for Payer: Healthscope Whirlpool |
$25.38
|
| Rate for Payer: Mclaren Commercial |
$22.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.57
|
| Rate for Payer: Nomi Health Commercial |
$20.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.33
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
|
OP
|
$100.62
|
|
|
Service Code
|
NDC 65042636
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.23 |
| Max. Negotiated Rate |
$100.62 |
| Rate for Payer: Aetna Commercial |
$90.56
|
| Rate for Payer: Aetna Medicare |
$37.23
|
| Rate for Payer: ASR ASR |
$97.60
|
| Rate for Payer: BCBS Complete |
$40.25
|
| Rate for Payer: BCBS Trust/PPO |
$82.96
|
| Rate for Payer: BCN Commercial |
$82.96
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cofinity Commercial |
$94.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.50
|
| Rate for Payer: Healthscope Commercial |
$97.60
|
| Rate for Payer: Healthscope Whirlpool |
$100.62
|
| Rate for Payer: Mclaren Commercial |
$90.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.53
|
| Rate for Payer: Nomi Health Commercial |
$82.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$88.16
|
| Rate for Payer: Priority Health Narrow Network |
$70.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.55
|
|
