|
CHLORDIAZEPOXIDE 25 MG CAPSULE
|
Facility
|
IP
|
$345.45
|
|
|
Service Code
|
NDC 0555-0159-02
|
| Hospital Charge Code |
1623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.82 |
| Max. Negotiated Rate |
$345.45 |
| Rate for Payer: Aetna Commercial |
$310.90
|
| Rate for Payer: ASR ASR |
$335.09
|
| Rate for Payer: BCBS Trust/PPO |
$267.83
|
| Rate for Payer: BCN Commercial |
$267.83
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$324.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.36
|
| Rate for Payer: Healthscope Commercial |
$345.45
|
| Rate for Payer: Healthscope Whirlpool |
$335.09
|
| Rate for Payer: Mclaren Commercial |
$310.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$293.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.00
|
|
|
CHLORDIAZEPOXIDE 5 MG CAPSULE
|
Facility
|
IP
|
$2.87
|
|
|
Service Code
|
NDC 51079-374-01
|
| Hospital Charge Code |
1624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: ASR ASR |
$2.78
|
| Rate for Payer: BCBS Trust/PPO |
$2.23
|
| Rate for Payer: BCN Commercial |
$2.23
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.87
|
| Rate for Payer: Healthscope Whirlpool |
$2.78
|
| Rate for Payer: Mclaren Commercial |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.53
|
|
|
CHLORDIAZEPOXIDE 5 MG CAPSULE
|
Facility
|
IP
|
$401.85
|
|
|
Service Code
|
NDC 0555-0158-02
|
| Hospital Charge Code |
1624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.30 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna Commercial |
$361.66
|
| Rate for Payer: ASR ASR |
$389.79
|
| Rate for Payer: BCBS Trust/PPO |
$311.55
|
| Rate for Payer: BCN Commercial |
$311.55
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Commercial |
$377.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Healthscope Whirlpool |
$389.79
|
| Rate for Payer: Mclaren Commercial |
$361.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$341.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$353.63
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$1,307.95
|
|
|
Service Code
|
NDC 0832-0301-00
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$915.56 |
| Max. Negotiated Rate |
$1,307.95 |
| Rate for Payer: Aetna Commercial |
$1,177.16
|
| Rate for Payer: ASR ASR |
$1,268.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,014.05
|
| Rate for Payer: BCN Commercial |
$1,014.05
|
| Rate for Payer: Cash Price |
$1,046.36
|
| Rate for Payer: Cofinity Commercial |
$1,229.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.36
|
| Rate for Payer: Healthscope Commercial |
$1,307.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,268.71
|
| Rate for Payer: Mclaren Commercial |
$1,177.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,111.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$915.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,151.00
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$3.33
|
|
|
Service Code
|
NDC 50268-167-11
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: ASR ASR |
$3.23
|
| Rate for Payer: BCBS Trust/PPO |
$2.58
|
| Rate for Payer: BCN Commercial |
$2.58
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cofinity Commercial |
$3.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$3.33
|
| Rate for Payer: Healthscope Whirlpool |
$3.23
|
| Rate for Payer: Mclaren Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.93
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$8.69
|
|
|
Service Code
|
NDC 51079-058-01
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.08 |
| Max. Negotiated Rate |
$8.69 |
| Rate for Payer: Aetna Commercial |
$7.82
|
| Rate for Payer: ASR ASR |
$8.43
|
| Rate for Payer: BCBS Trust/PPO |
$6.74
|
| Rate for Payer: BCN Commercial |
$6.74
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Cofinity Commercial |
$8.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.95
|
| Rate for Payer: Healthscope Commercial |
$8.69
|
| Rate for Payer: Healthscope Whirlpool |
$8.43
|
| Rate for Payer: Mclaren Commercial |
$7.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.65
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$166.32
|
|
|
Service Code
|
NDC 50268-167-15
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.42 |
| Max. Negotiated Rate |
$166.32 |
| Rate for Payer: Aetna Commercial |
$149.69
|
| Rate for Payer: ASR ASR |
$161.33
|
| Rate for Payer: BCBS Trust/PPO |
$128.95
|
| Rate for Payer: BCN Commercial |
$128.95
|
| Rate for Payer: Cash Price |
$133.06
|
| Rate for Payer: Cofinity Commercial |
$156.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.06
|
| Rate for Payer: Healthscope Commercial |
$166.32
|
| Rate for Payer: Healthscope Whirlpool |
$161.33
|
| Rate for Payer: Mclaren Commercial |
$149.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.36
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$213.75
|
|
|
Service Code
|
NDC 57664-648-88
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.62 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$192.38
|
| Rate for Payer: ASR ASR |
$207.34
|
| Rate for Payer: BCBS Trust/PPO |
$165.72
|
| Rate for Payer: BCN Commercial |
$165.72
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cofinity Commercial |
$200.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.00
|
| Rate for Payer: Healthscope Commercial |
$213.75
|
| Rate for Payer: Healthscope Whirlpool |
$207.34
|
| Rate for Payer: Mclaren Commercial |
$192.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$181.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.10
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$157.45
|
|
|
Service Code
|
NDC 43598-719-01
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.22 |
| Max. Negotiated Rate |
$157.45 |
| Rate for Payer: Aetna Commercial |
$141.70
|
| Rate for Payer: ASR ASR |
$152.73
|
| Rate for Payer: BCBS Trust/PPO |
$122.07
|
| Rate for Payer: BCN Commercial |
$122.07
|
| Rate for Payer: Cash Price |
$125.96
|
| Rate for Payer: Cofinity Commercial |
$148.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.96
|
| Rate for Payer: Healthscope Commercial |
$157.45
|
| Rate for Payer: Healthscope Whirlpool |
$152.73
|
| Rate for Payer: Mclaren Commercial |
$141.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.56
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$203.62
|
|
|
Service Code
|
NDC 0904-6900-04
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.53 |
| Max. Negotiated Rate |
$203.62 |
| Rate for Payer: Aetna Commercial |
$183.26
|
| Rate for Payer: ASR ASR |
$197.51
|
| Rate for Payer: BCBS Trust/PPO |
$157.87
|
| Rate for Payer: BCN Commercial |
$157.87
|
| Rate for Payer: Cash Price |
$162.89
|
| Rate for Payer: Cofinity Commercial |
$191.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.90
|
| Rate for Payer: Healthscope Commercial |
$203.62
|
| Rate for Payer: Healthscope Whirlpool |
$197.51
|
| Rate for Payer: Mclaren Commercial |
$183.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.19
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$324.30
|
|
|
Service Code
|
NDC 7583402001
|
| Hospital Charge Code |
88945
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.01 |
| Max. Negotiated Rate |
$324.30 |
| Rate for Payer: Aetna Commercial |
$291.87
|
| Rate for Payer: ASR ASR |
$314.57
|
| Rate for Payer: BCBS Trust/PPO |
$251.43
|
| Rate for Payer: BCN Commercial |
$251.43
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Commercial |
$304.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Healthscope Commercial |
$324.30
|
| Rate for Payer: Healthscope Whirlpool |
$314.57
|
| Rate for Payer: Mclaren Commercial |
$291.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$275.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.38
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$30.55
|
|
|
Service Code
|
NDC 904582460
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.38 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Aetna Commercial |
$27.50
|
| Rate for Payer: ASR ASR |
$29.63
|
| Rate for Payer: BCBS Trust/PPO |
$23.69
|
| Rate for Payer: BCN Commercial |
$23.69
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$28.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.44
|
| Rate for Payer: Healthscope Commercial |
$30.55
|
| Rate for Payer: Healthscope Whirlpool |
$29.63
|
| Rate for Payer: Mclaren Commercial |
$27.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.88
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$35.25
|
|
|
Service Code
|
NDC 536333401
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.68 |
| Max. Negotiated Rate |
$35.25 |
| Rate for Payer: Aetna Commercial |
$31.72
|
| Rate for Payer: ASR ASR |
$34.19
|
| Rate for Payer: BCBS Trust/PPO |
$27.33
|
| Rate for Payer: BCN Commercial |
$27.33
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cofinity Commercial |
$33.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.20
|
| Rate for Payer: Healthscope Commercial |
$35.25
|
| Rate for Payer: Healthscope Whirlpool |
$34.19
|
| Rate for Payer: Mclaren Commercial |
$31.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.02
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$133.95
|
|
|
Service Code
|
NDC 3160401870
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.76 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$120.56
|
| Rate for Payer: ASR ASR |
$129.93
|
| Rate for Payer: BCBS Trust/PPO |
$103.85
|
| Rate for Payer: BCN Commercial |
$103.85
|
| Rate for Payer: Cash Price |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$125.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.16
|
| Rate for Payer: Healthscope Commercial |
$133.95
|
| Rate for Payer: Healthscope Whirlpool |
$129.93
|
| Rate for Payer: Mclaren Commercial |
$120.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.88
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$224.20
|
|
|
Service Code
|
NDC 4843310401
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.94 |
| Max. Negotiated Rate |
$224.20 |
| Rate for Payer: Aetna Commercial |
$201.78
|
| Rate for Payer: ASR ASR |
$217.47
|
| Rate for Payer: BCBS Trust/PPO |
$173.82
|
| Rate for Payer: BCN Commercial |
$173.82
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Commercial |
$210.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Healthscope Commercial |
$224.20
|
| Rate for Payer: Healthscope Whirlpool |
$217.47
|
| Rate for Payer: Mclaren Commercial |
$201.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$190.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.30
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$25,369.27
|
|
|
Service Code
|
MS-DRG 415
|
| Min. Negotiated Rate |
$17,488.40 |
| Max. Negotiated Rate |
$25,369.27 |
| Rate for Payer: Aetna Medicare |
$18,408.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,011.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,011.05
|
| Rate for Payer: BCBS MAPPO |
$18,408.84
|
| Rate for Payer: BCN Medicare Advantage |
$18,408.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,408.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,408.84
|
| Rate for Payer: Mclaren Medicare |
$18,408.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,329.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,170.17
|
| Rate for Payer: PACE Medicare |
$17,488.40
|
| Rate for Payer: PACE SWMI |
$18,408.84
|
| Rate for Payer: PHP Commercial |
$20,249.72
|
| Rate for Payer: PHP Medicare Advantage |
$18,408.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,369.27
|
| Rate for Payer: Priority Health Medicare |
$18,408.84
|
| Rate for Payer: Priority Health Narrow Network |
$20,295.42
|
| Rate for Payer: Railroad Medicare Medicare |
$18,408.84
|
| Rate for Payer: UHC Medicare Advantage |
$18,961.11
|
| Rate for Payer: VA VA |
$18,408.84
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$45,263.57
|
|
|
Service Code
|
MS-DRG 414
|
| Min. Negotiated Rate |
$29,950.36 |
| Max. Negotiated Rate |
$45,263.57 |
| Rate for Payer: Aetna Medicare |
$31,526.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39,408.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39,408.36
|
| Rate for Payer: BCBS MAPPO |
$31,526.69
|
| Rate for Payer: BCN Medicare Advantage |
$31,526.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,526.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$31,526.69
|
| Rate for Payer: Mclaren Medicare |
$31,526.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33,103.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36,255.69
|
| Rate for Payer: PACE Medicare |
$29,950.36
|
| Rate for Payer: PACE SWMI |
$31,526.69
|
| Rate for Payer: PHP Commercial |
$34,679.36
|
| Rate for Payer: PHP Medicare Advantage |
$31,526.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45,263.57
|
| Rate for Payer: Priority Health Medicare |
$31,526.69
|
| Rate for Payer: Priority Health Narrow Network |
$36,210.86
|
| Rate for Payer: Railroad Medicare Medicare |
$31,526.69
|
| Rate for Payer: UHC Medicare Advantage |
$32,472.49
|
| Rate for Payer: VA VA |
$31,526.69
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$17,195.33
|
|
|
Service Code
|
MS-DRG 416
|
| Min. Negotiated Rate |
$12,368.17 |
| Max. Negotiated Rate |
$17,195.33 |
| Rate for Payer: Aetna Medicare |
$13,019.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,273.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,273.91
|
| Rate for Payer: BCBS MAPPO |
$13,019.13
|
| Rate for Payer: BCN Medicare Advantage |
$13,019.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,019.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,019.13
|
| Rate for Payer: Mclaren Medicare |
$13,019.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,670.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,972.00
|
| Rate for Payer: PACE Medicare |
$12,368.17
|
| Rate for Payer: PACE SWMI |
$13,019.13
|
| Rate for Payer: PHP Commercial |
$14,321.04
|
| Rate for Payer: PHP Medicare Advantage |
$13,019.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,195.33
|
| Rate for Payer: Priority Health Medicare |
$13,019.13
|
| Rate for Payer: Priority Health Narrow Network |
$13,756.26
|
| Rate for Payer: Railroad Medicare Medicare |
$13,019.13
|
| Rate for Payer: UHC Medicare Advantage |
$13,409.70
|
| Rate for Payer: VA VA |
$13,019.13
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITH CC
|
Facility
|
IP
|
$26,264.22
|
|
|
Service Code
|
MS-DRG 412
|
| Min. Negotiated Rate |
$18,214.69 |
| Max. Negotiated Rate |
$26,264.22 |
| Rate for Payer: Aetna Medicare |
$19,173.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,966.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,966.70
|
| Rate for Payer: BCBS MAPPO |
$19,173.36
|
| Rate for Payer: BCN Medicare Advantage |
$19,173.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,173.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$19,173.36
|
| Rate for Payer: Mclaren Medicare |
$19,173.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,132.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,049.36
|
| Rate for Payer: PACE Medicare |
$18,214.69
|
| Rate for Payer: PACE SWMI |
$19,173.36
|
| Rate for Payer: PHP Commercial |
$21,090.70
|
| Rate for Payer: PHP Medicare Advantage |
$19,173.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,264.22
|
| Rate for Payer: Priority Health Medicare |
$19,173.36
|
| Rate for Payer: Priority Health Narrow Network |
$21,011.38
|
| Rate for Payer: Railroad Medicare Medicare |
$19,173.36
|
| Rate for Payer: UHC Medicare Advantage |
$19,748.56
|
| Rate for Payer: VA VA |
$19,173.36
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITH MCC
|
Facility
|
IP
|
$36,985.62
|
|
|
Service Code
|
MS-DRG 411
|
| Min. Negotiated Rate |
$26,051.07 |
| Max. Negotiated Rate |
$36,985.62 |
| Rate for Payer: Aetna Medicare |
$27,422.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,277.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,277.72
|
| Rate for Payer: BCBS MAPPO |
$27,422.18
|
| Rate for Payer: BCN Medicare Advantage |
$27,422.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,422.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$27,422.18
|
| Rate for Payer: Mclaren Medicare |
$27,422.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28,793.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,535.51
|
| Rate for Payer: PACE Medicare |
$26,051.07
|
| Rate for Payer: PACE SWMI |
$27,422.18
|
| Rate for Payer: PHP Commercial |
$30,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$27,422.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,985.62
|
| Rate for Payer: Priority Health Medicare |
$27,422.18
|
| Rate for Payer: Priority Health Narrow Network |
$29,588.50
|
| Rate for Payer: Railroad Medicare Medicare |
$27,422.18
|
| Rate for Payer: UHC Medicare Advantage |
$28,244.85
|
| Rate for Payer: VA VA |
$27,422.18
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$19,383.26
|
|
|
Service Code
|
MS-DRG 413
|
| Min. Negotiated Rate |
$13,738.71 |
| Max. Negotiated Rate |
$19,383.26 |
| Rate for Payer: Aetna Medicare |
$14,461.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,077.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,077.25
|
| Rate for Payer: BCBS MAPPO |
$14,461.80
|
| Rate for Payer: BCN Medicare Advantage |
$14,461.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,461.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,461.80
|
| Rate for Payer: Mclaren Medicare |
$14,461.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,184.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,631.07
|
| Rate for Payer: PACE Medicare |
$13,738.71
|
| Rate for Payer: PACE SWMI |
$14,461.80
|
| Rate for Payer: PHP Commercial |
$15,907.98
|
| Rate for Payer: PHP Medicare Advantage |
$14,461.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,383.26
|
| Rate for Payer: Priority Health Medicare |
$14,461.80
|
| Rate for Payer: Priority Health Narrow Network |
$15,506.61
|
| Rate for Payer: Railroad Medicare Medicare |
$14,461.80
|
| Rate for Payer: UHC Medicare Advantage |
$14,895.65
|
| Rate for Payer: VA VA |
$14,461.80
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET
|
Facility
|
IP
|
$3.77
|
|
|
Service Code
|
NDC 49884-465-64
|
| Hospital Charge Code |
9588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: ASR ASR |
$3.66
|
| Rate for Payer: BCBS Trust/PPO |
$2.92
|
| Rate for Payer: BCN Commercial |
$2.92
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$3.77
|
| Rate for Payer: Healthscope Whirlpool |
$3.66
|
| Rate for Payer: Mclaren Commercial |
$3.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.32
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET
|
Facility
|
IP
|
$226.37
|
|
|
Service Code
|
NDC 49884-465-65
|
| Hospital Charge Code |
9588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.46 |
| Max. Negotiated Rate |
$226.37 |
| Rate for Payer: Aetna Commercial |
$203.73
|
| Rate for Payer: ASR ASR |
$219.58
|
| Rate for Payer: BCBS Trust/PPO |
$175.50
|
| Rate for Payer: BCN Commercial |
$175.50
|
| Rate for Payer: Cash Price |
$181.09
|
| Rate for Payer: Cofinity Commercial |
$212.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.10
|
| Rate for Payer: Healthscope Commercial |
$226.37
|
| Rate for Payer: Healthscope Whirlpool |
$219.58
|
| Rate for Payer: Mclaren Commercial |
$203.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.21
|
|
|
CHONDROITIN-SOD HYALURON 3 %-4 %(0.5 ML)1 %(0.55 ML)INTRAOCULAR SYRING
|
Facility
|
IP
|
$345.53
|
|
|
Service Code
|
NDC 8065183150
|
| Hospital Charge Code |
28917
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$241.87 |
| Max. Negotiated Rate |
$345.53 |
| Rate for Payer: Aetna Commercial |
$310.98
|
| Rate for Payer: ASR ASR |
$335.16
|
| Rate for Payer: BCBS Trust/PPO |
$267.89
|
| Rate for Payer: BCN Commercial |
$267.89
|
| Rate for Payer: Cash Price |
$276.43
|
| Rate for Payer: Cofinity Commercial |
$324.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.42
|
| Rate for Payer: Healthscope Commercial |
$345.53
|
| Rate for Payer: Healthscope Whirlpool |
$335.16
|
| Rate for Payer: Mclaren Commercial |
$310.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$293.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.07
|
|
|
CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE
|
Facility
|
IP
|
$218.01
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
28923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$218.01 |
| Rate for Payer: Aetna Commercial |
$196.21
|
| Rate for Payer: ASR ASR |
$211.47
|
| Rate for Payer: BCBS Trust/PPO |
$169.02
|
| Rate for Payer: BCN Commercial |
$169.02
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cofinity Commercial |
$204.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.41
|
| Rate for Payer: Healthscope Commercial |
$218.01
|
| Rate for Payer: Healthscope Whirlpool |
$211.47
|
| Rate for Payer: Mclaren Commercial |
$196.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.85
|
|
