|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$186.56
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
9186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$186.56 |
| Rate for Payer: Aetna Commercial |
$167.91
|
| Rate for Payer: Aetna Commercial |
$176.65
|
| Rate for Payer: Aetna Commercial |
$187.98
|
| Rate for Payer: Aetna Medicare |
$72.62
|
| Rate for Payer: Aetna Medicare |
$69.03
|
| Rate for Payer: Aetna Medicare |
$77.28
|
| Rate for Payer: ASR ASR |
$202.60
|
| Rate for Payer: ASR ASR |
$180.97
|
| Rate for Payer: ASR ASR |
$190.39
|
| Rate for Payer: BCBS Complete |
$74.62
|
| Rate for Payer: BCBS Complete |
$83.55
|
| Rate for Payer: BCBS Complete |
$78.51
|
| Rate for Payer: BCBS Trust/PPO |
$153.82
|
| Rate for Payer: BCBS Trust/PPO |
$161.83
|
| Rate for Payer: BCBS Trust/PPO |
$172.21
|
| Rate for Payer: BCN Commercial |
$153.82
|
| Rate for Payer: BCN Commercial |
$161.83
|
| Rate for Payer: BCN Commercial |
$172.21
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cofinity Commercial |
$184.50
|
| Rate for Payer: Cofinity Commercial |
$175.37
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.02
|
| Rate for Payer: Healthscope Commercial |
$202.60
|
| Rate for Payer: Healthscope Commercial |
$180.97
|
| Rate for Payer: Healthscope Commercial |
$190.39
|
| Rate for Payer: Healthscope Whirlpool |
$196.28
|
| Rate for Payer: Healthscope Whirlpool |
$186.56
|
| Rate for Payer: Healthscope Whirlpool |
$208.87
|
| Rate for Payer: Mclaren Commercial |
$187.98
|
| Rate for Payer: Mclaren Commercial |
$176.65
|
| Rate for Payer: Mclaren Commercial |
$167.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.58
|
| Rate for Payer: Nomi Health Commercial |
$171.27
|
| Rate for Payer: Nomi Health Commercial |
$152.98
|
| Rate for Payer: Nomi Health Commercial |
$160.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.32
|
| Rate for Payer: Priority Health Narrow Network |
$1.86
|
| Rate for Payer: Priority Health Narrow Network |
$1.86
|
| Rate for Payer: Priority Health Narrow Network |
$1.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.17
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$208.87
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$156.65 |
| Max. Negotiated Rate |
$208.87 |
| Rate for Payer: Aetna Commercial |
$187.98
|
| Rate for Payer: ASR ASR |
$202.60
|
| Rate for Payer: BCBS Trust/PPO |
$171.52
|
| Rate for Payer: BCN Commercial |
$171.52
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.10
|
| Rate for Payer: Healthscope Commercial |
$202.60
|
| Rate for Payer: Healthscope Whirlpool |
$208.87
|
| Rate for Payer: Mclaren Commercial |
$187.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: Nomi Health Commercial |
$171.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.81
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$208.87
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
301706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$208.87 |
| Rate for Payer: Aetna Commercial |
$187.98
|
| Rate for Payer: Aetna Medicare |
$77.28
|
| Rate for Payer: ASR ASR |
$202.60
|
| Rate for Payer: BCBS Complete |
$83.55
|
| Rate for Payer: BCBS Trust/PPO |
$172.21
|
| Rate for Payer: BCN Commercial |
$172.21
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.10
|
| Rate for Payer: Healthscope Commercial |
$202.60
|
| Rate for Payer: Healthscope Whirlpool |
$208.87
|
| Rate for Payer: Mclaren Commercial |
$187.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.54
|
| Rate for Payer: Nomi Health Commercial |
$171.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.32
|
| Rate for Payer: Priority Health Narrow Network |
$1.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.81
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$9.90
|
|
|
Service Code
|
NDC 16784011631
|
| Hospital Charge Code |
850
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: Aetna Medicare |
$3.66
|
| Rate for Payer: ASR ASR |
$9.60
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS Trust/PPO |
$8.16
|
| Rate for Payer: BCN Commercial |
$8.16
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$9.60
|
| Rate for Payer: Healthscope Whirlpool |
$9.90
|
| Rate for Payer: Mclaren Commercial |
$8.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.41
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.67
|
| Rate for Payer: Priority Health Narrow Network |
$6.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.71
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$9.90
|
|
|
Service Code
|
NDC 16784011631
|
| Hospital Charge Code |
850
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: ASR ASR |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$8.13
|
| Rate for Payer: BCN Commercial |
$8.13
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$9.60
|
| Rate for Payer: Healthscope Whirlpool |
$9.90
|
| Rate for Payer: Mclaren Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.41
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.71
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$10.22
|
|
|
Service Code
|
NDC 16784011731
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$10.22 |
| Rate for Payer: Aetna Commercial |
$9.20
|
| Rate for Payer: ASR ASR |
$9.92
|
| Rate for Payer: BCBS Trust/PPO |
$8.40
|
| Rate for Payer: BCN Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$9.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Healthscope Commercial |
$9.92
|
| Rate for Payer: Healthscope Whirlpool |
$10.22
|
| Rate for Payer: Mclaren Commercial |
$9.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.69
|
| Rate for Payer: Nomi Health Commercial |
$8.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.00
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$10.46
|
|
|
Service Code
|
NDC 536126328
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna Commercial |
$9.41
|
| Rate for Payer: Aetna Medicare |
$3.87
|
| Rate for Payer: ASR ASR |
$10.14
|
| Rate for Payer: BCBS Complete |
$4.18
|
| Rate for Payer: BCBS Trust/PPO |
$8.62
|
| Rate for Payer: BCN Commercial |
$8.62
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$9.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$10.14
|
| Rate for Payer: Healthscope Whirlpool |
$10.46
|
| Rate for Payer: Mclaren Commercial |
$9.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: Nomi Health Commercial |
$8.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.16
|
| Rate for Payer: Priority Health Narrow Network |
$7.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.20
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$10.22
|
|
|
Service Code
|
NDC 16784011731
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$10.22 |
| Rate for Payer: Aetna Commercial |
$9.20
|
| Rate for Payer: Aetna Medicare |
$3.78
|
| Rate for Payer: ASR ASR |
$9.92
|
| Rate for Payer: BCBS Complete |
$4.09
|
| Rate for Payer: BCBS Trust/PPO |
$8.43
|
| Rate for Payer: BCN Commercial |
$8.43
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$9.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Healthscope Commercial |
$9.92
|
| Rate for Payer: Healthscope Whirlpool |
$10.22
|
| Rate for Payer: Mclaren Commercial |
$9.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.69
|
| Rate for Payer: Nomi Health Commercial |
$8.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.96
|
| Rate for Payer: Priority Health Narrow Network |
$7.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.00
|
|
|
BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$10.46
|
|
|
Service Code
|
NDC 536126328
|
| Hospital Charge Code |
13818
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna Commercial |
$9.41
|
| Rate for Payer: ASR ASR |
$10.14
|
| Rate for Payer: BCBS Trust/PPO |
$8.59
|
| Rate for Payer: BCN Commercial |
$8.59
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$9.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$10.14
|
| Rate for Payer: Healthscope Whirlpool |
$10.46
|
| Rate for Payer: Mclaren Commercial |
$9.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.89
|
| Rate for Payer: Nomi Health Commercial |
$8.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.20
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC
|
Facility
|
IP
|
$27,480.35
|
|
|
Service Code
|
MSDRG 519
|
| Min. Negotiated Rate |
$15,350.47 |
| Max. Negotiated Rate |
$27,480.35 |
| Rate for Payer: Aetna Medicare |
$16,158.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,197.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,197.99
|
| Rate for Payer: BCBS MAPPO |
$16,158.39
|
| Rate for Payer: BCN Medicare Advantage |
$16,158.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,158.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,158.39
|
| Rate for Payer: Mclaren Medicare |
$16,158.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,966.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,582.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,774.23
|
| Rate for Payer: PACE Medicare |
$15,350.47
|
| Rate for Payer: PACE SWMI |
$16,158.39
|
| Rate for Payer: PHP Commercial |
$17,774.23
|
| Rate for Payer: PHP Medicare Advantage |
$16,158.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27,480.35
|
| Rate for Payer: Priority Health Medicare |
$16,158.39
|
| Rate for Payer: Priority Health Narrow Network |
$21,984.28
|
| Rate for Payer: Railroad Medicare Medicare |
$16,158.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,158.39
|
| Rate for Payer: UHC Exchange |
$25,045.50
|
| Rate for Payer: UHCCP DNSP |
$16,158.39
|
| Rate for Payer: VA VA |
$16,158.39
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR
|
Facility
|
IP
|
$51,346.02
|
|
|
Service Code
|
MSDRG 518
|
| Min. Negotiated Rate |
$27,234.29 |
| Max. Negotiated Rate |
$51,346.02 |
| Rate for Payer: Aetna Medicare |
$28,667.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,834.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,834.59
|
| Rate for Payer: BCBS MAPPO |
$28,667.67
|
| Rate for Payer: BCN Medicare Advantage |
$28,667.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,667.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$28,667.67
|
| Rate for Payer: Mclaren Medicare |
$28,667.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30,101.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,967.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$31,534.44
|
| Rate for Payer: PACE Medicare |
$27,234.29
|
| Rate for Payer: PACE SWMI |
$28,667.67
|
| Rate for Payer: PHP Commercial |
$31,534.44
|
| Rate for Payer: PHP Medicare Advantage |
$28,667.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$51,346.02
|
| Rate for Payer: Priority Health Medicare |
$28,667.67
|
| Rate for Payer: Priority Health Narrow Network |
$41,076.81
|
| Rate for Payer: Railroad Medicare Medicare |
$28,667.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28,667.67
|
| Rate for Payer: UHC Exchange |
$44,434.89
|
| Rate for Payer: UHCCP DNSP |
$28,667.67
|
| Rate for Payer: VA VA |
$28,667.67
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$20,524.39
|
|
|
Service Code
|
MSDRG 520
|
| Min. Negotiated Rate |
$11,886.77 |
| Max. Negotiated Rate |
$20,524.39 |
| Rate for Payer: Aetna Medicare |
$12,512.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,640.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,640.49
|
| Rate for Payer: BCBS MAPPO |
$12,512.39
|
| Rate for Payer: BCN Medicare Advantage |
$12,512.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,512.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,512.39
|
| Rate for Payer: Mclaren Medicare |
$12,512.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,138.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,389.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,763.63
|
| Rate for Payer: PACE Medicare |
$11,886.77
|
| Rate for Payer: PACE SWMI |
$12,512.39
|
| Rate for Payer: PHP Commercial |
$13,763.63
|
| Rate for Payer: PHP Medicare Advantage |
$12,512.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20,524.39
|
| Rate for Payer: Priority Health Medicare |
$12,512.39
|
| Rate for Payer: Priority Health Narrow Network |
$16,419.51
|
| Rate for Payer: Railroad Medicare Medicare |
$12,512.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,512.39
|
| Rate for Payer: UHC Exchange |
$19,394.20
|
| Rate for Payer: UHCCP DNSP |
$12,512.39
|
| Rate for Payer: VA VA |
$12,512.39
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
OP
|
$353.40
|
|
|
Service Code
|
NDC 904647561
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.76 |
| Max. Negotiated Rate |
$353.40 |
| Rate for Payer: Aetna Commercial |
$318.06
|
| Rate for Payer: Aetna Medicare |
$130.76
|
| Rate for Payer: ASR ASR |
$342.80
|
| Rate for Payer: BCBS Complete |
$141.36
|
| Rate for Payer: BCBS Trust/PPO |
$291.38
|
| Rate for Payer: BCN Commercial |
$291.38
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Commercial |
$332.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Healthscope Commercial |
$342.80
|
| Rate for Payer: Healthscope Whirlpool |
$353.40
|
| Rate for Payer: Mclaren Commercial |
$318.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: Nomi Health Commercial |
$289.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$309.65
|
| Rate for Payer: Priority Health Narrow Network |
$247.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$310.99
|
|
|
BACLOFEN 10 MG TABLET
|
Facility
|
IP
|
$353.40
|
|
|
Service Code
|
NDC 904647561
|
| Hospital Charge Code |
860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$265.05 |
| Max. Negotiated Rate |
$353.40 |
| Rate for Payer: Aetna Commercial |
$318.06
|
| Rate for Payer: ASR ASR |
$342.80
|
| Rate for Payer: BCBS Trust/PPO |
$290.21
|
| Rate for Payer: BCN Commercial |
$290.21
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Commercial |
$332.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Healthscope Commercial |
$342.80
|
| Rate for Payer: Healthscope Whirlpool |
$353.40
|
| Rate for Payer: Mclaren Commercial |
$318.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: Nomi Health Commercial |
$289.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$310.99
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$8,994.94
|
|
|
Service Code
|
APR-DRG 0491
|
| Min. Negotiated Rate |
$8,132.51 |
| Max. Negotiated Rate |
$8,994.94 |
| Rate for Payer: BCBS Complete |
$8,994.94
|
| Rate for Payer: Mclaren Medicaid |
$8,566.61
|
| Rate for Payer: Meridian Medicaid |
$8,994.94
|
| Rate for Payer: PHP Medicaid |
$8,132.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,566.61
|
| Rate for Payer: UHC Medicaid |
$8,566.61
|
| Rate for Payer: UHCCP Medicaid |
$8,566.61
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$13,527.84
|
|
|
Service Code
|
APR-DRG 0493
|
| Min. Negotiated Rate |
$12,230.78 |
| Max. Negotiated Rate |
$13,527.84 |
| Rate for Payer: BCBS Complete |
$13,527.84
|
| Rate for Payer: Mclaren Medicaid |
$12,883.66
|
| Rate for Payer: Meridian Medicaid |
$13,527.84
|
| Rate for Payer: PHP Medicaid |
$12,230.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,883.66
|
| Rate for Payer: UHC Medicaid |
$12,883.66
|
| Rate for Payer: UHCCP Medicaid |
$12,883.66
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$17,395.89
|
|
|
Service Code
|
APR-DRG 0494
|
| Min. Negotiated Rate |
$15,727.97 |
| Max. Negotiated Rate |
$17,395.89 |
| Rate for Payer: BCBS Complete |
$17,395.89
|
| Rate for Payer: Mclaren Medicaid |
$16,567.52
|
| Rate for Payer: Meridian Medicaid |
$17,395.89
|
| Rate for Payer: PHP Medicaid |
$15,727.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,567.52
|
| Rate for Payer: UHC Medicaid |
$16,567.52
|
| Rate for Payer: UHCCP Medicaid |
$16,567.52
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$9,470.14
|
|
|
Service Code
|
APR-DRG 0492
|
| Min. Negotiated Rate |
$8,562.14 |
| Max. Negotiated Rate |
$9,470.14 |
| Rate for Payer: BCBS Complete |
$9,470.14
|
| Rate for Payer: Mclaren Medicaid |
$9,019.18
|
| Rate for Payer: Meridian Medicaid |
$9,470.14
|
| Rate for Payer: PHP Medicaid |
$8,562.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,019.18
|
| Rate for Payer: UHC Medicaid |
$9,019.18
|
| Rate for Payer: UHCCP Medicaid |
$9,019.18
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC
|
Facility
|
IP
|
$35,435.11
|
|
|
Service Code
|
MSDRG 095
|
| Min. Negotiated Rate |
$19,311.51 |
| Max. Negotiated Rate |
$35,435.11 |
| Rate for Payer: Aetna Medicare |
$20,327.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,409.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,409.88
|
| Rate for Payer: BCBS MAPPO |
$20,327.90
|
| Rate for Payer: BCN Medicare Advantage |
$20,327.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,327.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$20,327.90
|
| Rate for Payer: Mclaren Medicare |
$20,327.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,344.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,377.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,360.69
|
| Rate for Payer: PACE Medicare |
$19,311.51
|
| Rate for Payer: PACE SWMI |
$20,327.90
|
| Rate for Payer: PHP Commercial |
$22,360.69
|
| Rate for Payer: PHP Medicare Advantage |
$20,327.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$35,435.11
|
| Rate for Payer: Priority Health Medicare |
$20,327.90
|
| Rate for Payer: Priority Health Narrow Network |
$28,348.09
|
| Rate for Payer: Railroad Medicare Medicare |
$20,327.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,327.90
|
| Rate for Payer: UHC Exchange |
$31,508.24
|
| Rate for Payer: UHCCP DNSP |
$20,327.90
|
| Rate for Payer: VA VA |
$20,327.90
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC
|
Facility
|
IP
|
$48,352.33
|
|
|
Service Code
|
MSDRG 094
|
| Min. Negotiated Rate |
$25,743.59 |
| Max. Negotiated Rate |
$48,352.33 |
| Rate for Payer: Aetna Medicare |
$27,098.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,873.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,873.15
|
| Rate for Payer: BCBS MAPPO |
$27,098.52
|
| Rate for Payer: BCN Medicare Advantage |
$27,098.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,098.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$27,098.52
|
| Rate for Payer: Mclaren Medicare |
$27,098.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28,453.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,163.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$29,808.37
|
| Rate for Payer: PACE Medicare |
$25,743.59
|
| Rate for Payer: PACE SWMI |
$27,098.52
|
| Rate for Payer: PHP Commercial |
$29,808.37
|
| Rate for Payer: PHP Medicare Advantage |
$27,098.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$48,352.33
|
| Rate for Payer: Priority Health Medicare |
$27,098.52
|
| Rate for Payer: Priority Health Narrow Network |
$38,681.87
|
| Rate for Payer: Railroad Medicare Medicare |
$27,098.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27,098.52
|
| Rate for Payer: UHC Exchange |
$42,002.71
|
| Rate for Payer: UHCCP DNSP |
$27,098.52
|
| Rate for Payer: VA VA |
$27,098.52
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC
|
Facility
|
IP
|
$35,435.11
|
|
|
Service Code
|
MSDRG 096
|
| Min. Negotiated Rate |
$19,311.51 |
| Max. Negotiated Rate |
$35,435.11 |
| Rate for Payer: Aetna Medicare |
$20,327.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,409.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,409.88
|
| Rate for Payer: BCBS MAPPO |
$20,327.90
|
| Rate for Payer: BCN Medicare Advantage |
$20,327.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,327.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$20,327.90
|
| Rate for Payer: Mclaren Medicare |
$20,327.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,344.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,377.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,360.69
|
| Rate for Payer: PACE Medicare |
$19,311.51
|
| Rate for Payer: PACE SWMI |
$20,327.90
|
| Rate for Payer: PHP Commercial |
$22,360.69
|
| Rate for Payer: PHP Medicare Advantage |
$20,327.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$35,435.11
|
| Rate for Payer: Priority Health Medicare |
$20,327.90
|
| Rate for Payer: Priority Health Narrow Network |
$28,348.09
|
| Rate for Payer: Railroad Medicare Medicare |
$20,327.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,327.90
|
| Rate for Payer: UHC Exchange |
$31,508.24
|
| Rate for Payer: UHCCP DNSP |
$20,327.90
|
| Rate for Payer: VA VA |
$20,327.90
|
|
|
BALANCED SALT SOLUTION COMBINATION NO.2 INTRAOCULAR IRRIGATION
|
Facility
|
IP
|
$10.53
|
|
|
Service Code
|
NDC 65079515
|
| Hospital Charge Code |
10781
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Aetna Commercial |
$9.48
|
| Rate for Payer: ASR ASR |
$10.21
|
| Rate for Payer: BCBS Trust/PPO |
$8.65
|
| Rate for Payer: BCN Commercial |
$8.65
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Healthscope Commercial |
$10.21
|
| Rate for Payer: Healthscope Whirlpool |
$10.53
|
| Rate for Payer: Mclaren Commercial |
$9.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.95
|
| Rate for Payer: Nomi Health Commercial |
$8.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.27
|
|
|
BALANCED SALT SOLUTION COMBINATION NO.2 INTRAOCULAR IRRIGATION
|
Facility
|
OP
|
$10.53
|
|
|
Service Code
|
NDC 65079515
|
| Hospital Charge Code |
10781
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Aetna Commercial |
$9.48
|
| Rate for Payer: Aetna Medicare |
$3.90
|
| Rate for Payer: ASR ASR |
$10.21
|
| Rate for Payer: BCBS Complete |
$4.21
|
| Rate for Payer: BCBS Trust/PPO |
$8.68
|
| Rate for Payer: BCN Commercial |
$8.68
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Healthscope Commercial |
$10.21
|
| Rate for Payer: Healthscope Whirlpool |
$10.53
|
| Rate for Payer: Mclaren Commercial |
$9.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.95
|
| Rate for Payer: Nomi Health Commercial |
$8.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.23
|
| Rate for Payer: Priority Health Narrow Network |
$7.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.27
|
|
|
BARIUM SULFATE 700 MG TABLET
|
Facility
|
OP
|
$340.32
|
|
|
Service Code
|
NDC 10361077831
|
| Hospital Charge Code |
100992
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.92 |
| Max. Negotiated Rate |
$340.32 |
| Rate for Payer: Aetna Commercial |
$306.29
|
| Rate for Payer: Aetna Medicare |
$125.92
|
| Rate for Payer: ASR ASR |
$330.11
|
| Rate for Payer: BCBS Complete |
$136.13
|
| Rate for Payer: BCBS Trust/PPO |
$280.59
|
| Rate for Payer: BCN Commercial |
$280.59
|
| Rate for Payer: Cash Price |
$272.26
|
| Rate for Payer: Cofinity Commercial |
$319.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.26
|
| Rate for Payer: Healthscope Commercial |
$330.11
|
| Rate for Payer: Healthscope Whirlpool |
$340.32
|
| Rate for Payer: Mclaren Commercial |
$306.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.27
|
| Rate for Payer: Nomi Health Commercial |
$279.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$298.19
|
| Rate for Payer: Priority Health Narrow Network |
$238.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.48
|
|
|
BARIUM SULFATE 700 MG TABLET
|
Facility
|
IP
|
$340.32
|
|
|
Service Code
|
NDC 10361077831
|
| Hospital Charge Code |
100992
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.24 |
| Max. Negotiated Rate |
$340.32 |
| Rate for Payer: Aetna Commercial |
$306.29
|
| Rate for Payer: ASR ASR |
$330.11
|
| Rate for Payer: BCBS Trust/PPO |
$279.47
|
| Rate for Payer: BCN Commercial |
$279.47
|
| Rate for Payer: Cash Price |
$272.26
|
| Rate for Payer: Cofinity Commercial |
$319.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.26
|
| Rate for Payer: Healthscope Commercial |
$330.11
|
| Rate for Payer: Healthscope Whirlpool |
$340.32
|
| Rate for Payer: Mclaren Commercial |
$306.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.27
|
| Rate for Payer: Nomi Health Commercial |
$279.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.48
|
|
