|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC
|
Facility
IP
|
$22,830.80
|
|
|
Service Code
|
MS-DRG 896
|
| Min. Negotiated Rate |
$15,898.29 |
| Max. Negotiated Rate |
$22,830.80 |
| Rate for Payer: Aetna Medicare |
$16,735.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,918.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,918.80
|
| Rate for Payer: BCBS MAPPO |
$16,735.04
|
| Rate for Payer: BCN Medicare Advantage |
$16,735.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,735.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,735.04
|
| Rate for Payer: Mclaren Medicare |
$16,735.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,571.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,245.30
|
| Rate for Payer: PACE Medicare |
$15,898.29
|
| Rate for Payer: PACE SWMI |
$16,735.04
|
| Rate for Payer: PHP Commercial |
$18,408.54
|
| Rate for Payer: PHP Medicare Advantage |
$16,735.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,830.80
|
| Rate for Payer: Priority Health Medicare |
$16,735.04
|
| Rate for Payer: Priority Health Narrow Network |
$18,264.64
|
| Rate for Payer: Railroad Medicare Medicare |
$16,735.04
|
| Rate for Payer: UHC Medicare Advantage |
$17,237.09
|
| Rate for Payer: VA VA |
$16,735.04
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC
|
Facility
IP
|
$11,155.98
|
|
|
Service Code
|
MS-DRG 897
|
| Min. Negotiated Rate |
$8,478.54 |
| Max. Negotiated Rate |
$11,155.98 |
| Rate for Payer: Aetna Medicare |
$8,924.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,155.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,155.98
|
| Rate for Payer: BCBS MAPPO |
$8,924.78
|
| Rate for Payer: BCN Medicare Advantage |
$8,924.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,924.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,924.78
|
| Rate for Payer: Mclaren Medicare |
$8,924.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,371.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,263.50
|
| Rate for Payer: PACE Medicare |
$8,478.54
|
| Rate for Payer: PACE SWMI |
$8,924.78
|
| Rate for Payer: PHP Commercial |
$9,817.26
|
| Rate for Payer: PHP Medicare Advantage |
$8,924.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,985.90
|
| Rate for Payer: Priority Health Medicare |
$8,924.78
|
| Rate for Payer: Priority Health Narrow Network |
$8,788.72
|
| Rate for Payer: Railroad Medicare Medicare |
$8,924.78
|
| Rate for Payer: UHC Medicare Advantage |
$9,192.52
|
| Rate for Payer: VA VA |
$8,924.78
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY
|
Facility
IP
|
$20,656.99
|
|
|
Service Code
|
MS-DRG 895
|
| Min. Negotiated Rate |
$14,536.60 |
| Max. Negotiated Rate |
$20,656.99 |
| Rate for Payer: Aetna Medicare |
$15,301.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,127.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,127.10
|
| Rate for Payer: BCBS MAPPO |
$15,301.68
|
| Rate for Payer: BCN Medicare Advantage |
$15,301.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,301.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,301.68
|
| Rate for Payer: Mclaren Medicare |
$15,301.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,066.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,596.93
|
| Rate for Payer: PACE Medicare |
$14,536.60
|
| Rate for Payer: PACE SWMI |
$15,301.68
|
| Rate for Payer: PHP Commercial |
$16,831.85
|
| Rate for Payer: PHP Medicare Advantage |
$15,301.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,656.99
|
| Rate for Payer: Priority Health Medicare |
$15,301.68
|
| Rate for Payer: Priority Health Narrow Network |
$16,525.59
|
| Rate for Payer: Railroad Medicare Medicare |
$15,301.68
|
| Rate for Payer: UHC Medicare Advantage |
$15,760.73
|
| Rate for Payer: VA VA |
$15,301.68
|
|
|
ALLERGIC REACTIONS WITH MCC
|
Facility
IP
|
$22,778.16
|
|
|
Service Code
|
MS-DRG 915
|
| Min. Negotiated Rate |
$15,865.31 |
| Max. Negotiated Rate |
$22,778.16 |
| Rate for Payer: Aetna Medicare |
$16,700.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,875.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,875.41
|
| Rate for Payer: BCBS MAPPO |
$16,700.33
|
| Rate for Payer: BCN Medicare Advantage |
$16,700.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,700.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,700.33
|
| Rate for Payer: Mclaren Medicare |
$16,700.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,535.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,205.38
|
| Rate for Payer: PACE Medicare |
$15,865.31
|
| Rate for Payer: PACE SWMI |
$16,700.33
|
| Rate for Payer: PHP Commercial |
$18,370.36
|
| Rate for Payer: PHP Medicare Advantage |
$16,700.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,778.16
|
| Rate for Payer: Priority Health Medicare |
$16,700.33
|
| Rate for Payer: Priority Health Narrow Network |
$18,222.53
|
| Rate for Payer: Railroad Medicare Medicare |
$16,700.33
|
| Rate for Payer: UHC Medicare Advantage |
$17,201.34
|
| Rate for Payer: VA VA |
$16,700.33
|
|
|
ALLERGIC REACTIONS WITHOUT MCC
|
Facility
IP
|
$9,073.25
|
|
|
Service Code
|
MS-DRG 916
|
| Min. Negotiated Rate |
$6,767.19 |
| Max. Negotiated Rate |
$9,073.25 |
| Rate for Payer: Aetna Medicare |
$7,258.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,073.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,073.25
|
| Rate for Payer: BCBS MAPPO |
$7,258.60
|
| Rate for Payer: BCN Medicare Advantage |
$7,258.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,258.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,258.60
|
| Rate for Payer: Mclaren Medicare |
$7,258.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,621.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,347.39
|
| Rate for Payer: PACE Medicare |
$6,895.67
|
| Rate for Payer: PACE SWMI |
$7,258.60
|
| Rate for Payer: PHP Commercial |
$7,984.46
|
| Rate for Payer: PHP Medicare Advantage |
$7,258.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,458.99
|
| Rate for Payer: Priority Health Medicare |
$7,258.60
|
| Rate for Payer: Priority Health Narrow Network |
$6,767.19
|
| Rate for Payer: Railroad Medicare Medicare |
$7,258.60
|
| Rate for Payer: UHC Medicare Advantage |
$7,476.36
|
| Rate for Payer: VA VA |
$7,258.60
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
IP
|
$147,157.96
|
|
|
Service Code
|
MS-DRG 014
|
| Min. Negotiated Rate |
$93,777.79 |
| Max. Negotiated Rate |
$147,157.96 |
| Rate for Payer: Aetna Medicare |
$98,713.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$123,391.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$123,391.82
|
| Rate for Payer: BCBS MAPPO |
$98,713.46
|
| Rate for Payer: BCN Medicare Advantage |
$98,713.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98,713.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$98,713.46
|
| Rate for Payer: Mclaren Medicare |
$98,713.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$103,649.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113,520.48
|
| Rate for Payer: PACE Medicare |
$93,777.79
|
| Rate for Payer: PACE SWMI |
$98,713.46
|
| Rate for Payer: PHP Commercial |
$108,584.81
|
| Rate for Payer: PHP Medicare Advantage |
$98,713.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147,157.96
|
| Rate for Payer: Priority Health Medicare |
$98,713.46
|
| Rate for Payer: Priority Health Narrow Network |
$117,726.37
|
| Rate for Payer: Railroad Medicare Medicare |
$98,713.46
|
| Rate for Payer: UHC Medicare Advantage |
$101,674.86
|
| Rate for Payer: VA VA |
$98,713.46
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
IP
|
$3.65
|
|
|
Service Code
|
NDC 62584-988-11
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: ASR ASR |
$3.54
|
| Rate for Payer: BCBS Trust/PPO |
$2.83
|
| Rate for Payer: BCN Commercial |
$2.83
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.92
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Healthscope Whirlpool |
$3.54
|
| Rate for Payer: Mclaren Commercial |
$3.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.21
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
IP
|
$2.77
|
|
|
Service Code
|
NDC 51079-205-01
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.49
|
| Rate for Payer: ASR ASR |
$2.69
|
| Rate for Payer: BCBS Trust/PPO |
$2.15
|
| Rate for Payer: BCN Commercial |
$2.15
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.77
|
| Rate for Payer: Healthscope Whirlpool |
$2.69
|
| Rate for Payer: Mclaren Commercial |
$2.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.44
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
IP
|
$446.50
|
|
|
Service Code
|
NDC 0904-7041-61
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$312.55 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Aetna Commercial |
$401.85
|
| Rate for Payer: ASR ASR |
$433.10
|
| Rate for Payer: BCBS Trust/PPO |
$346.17
|
| Rate for Payer: BCN Commercial |
$346.17
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cofinity Commercial |
$419.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Healthscope Commercial |
$446.50
|
| Rate for Payer: Healthscope Whirlpool |
$433.10
|
| Rate for Payer: Mclaren Commercial |
$401.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$379.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$392.92
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
IP
|
$364.80
|
|
|
Service Code
|
NDC 62584-988-01
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.36 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna Commercial |
$328.32
|
| Rate for Payer: ASR ASR |
$353.86
|
| Rate for Payer: BCBS Trust/PPO |
$282.83
|
| Rate for Payer: BCN Commercial |
$282.83
|
| Rate for Payer: Cash Price |
$291.84
|
| Rate for Payer: Cofinity Commercial |
$342.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.84
|
| Rate for Payer: Healthscope Commercial |
$364.80
|
| Rate for Payer: Healthscope Whirlpool |
$353.86
|
| Rate for Payer: Mclaren Commercial |
$328.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$310.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.02
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
IP
|
$64.75
|
|
|
Service Code
|
NDC 65862-676-01
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.32 |
| Max. Negotiated Rate |
$64.75 |
| Rate for Payer: Aetna Commercial |
$58.28
|
| Rate for Payer: ASR ASR |
$62.81
|
| Rate for Payer: BCBS Trust/PPO |
$50.20
|
| Rate for Payer: BCN Commercial |
$50.20
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cofinity Commercial |
$60.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Healthscope Commercial |
$64.75
|
| Rate for Payer: Healthscope Whirlpool |
$62.81
|
| Rate for Payer: Mclaren Commercial |
$58.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.98
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
IP
|
$0.93
|
|
|
Service Code
|
NDC 51079-789-01
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: ASR ASR |
$0.90
|
| Rate for Payer: BCBS Trust/PPO |
$0.72
|
| Rate for Payer: BCN Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cofinity Commercial |
$0.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$0.93
|
| Rate for Payer: Healthscope Whirlpool |
$0.90
|
| Rate for Payer: Mclaren Commercial |
$0.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.82
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
IP
|
$57.75
|
|
|
Service Code
|
NDC 65862-677-01
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.42 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Aetna Commercial |
$51.98
|
| Rate for Payer: ASR ASR |
$56.02
|
| Rate for Payer: BCBS Trust/PPO |
$44.77
|
| Rate for Payer: BCN Commercial |
$44.77
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cofinity Commercial |
$54.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.20
|
| Rate for Payer: Healthscope Commercial |
$57.75
|
| Rate for Payer: Healthscope Whirlpool |
$56.02
|
| Rate for Payer: Mclaren Commercial |
$51.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.82
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20,185.20 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: BCBS Trust/PPO |
$22,356.55
|
| Rate for Payer: BCN Commercial |
$22,356.55
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$28,836.00
|
| Rate for Payer: Healthscope Whirlpool |
$27,970.92
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,510.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,185.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
|
|
ALTEPLASE 100 MG IV INFUSION FOR STROKE
|
Facility
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20,185.20 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: BCBS Trust/PPO |
$22,356.55
|
| Rate for Payer: BCN Commercial |
$22,356.55
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$28,836.00
|
| Rate for Payer: Healthscope Whirlpool |
$27,970.92
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,510.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,185.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
|
|
ALTEPLASE 100MG IV SOLUTION FOR PE
|
Facility
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20,185.20 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: BCBS Trust/PPO |
$22,356.55
|
| Rate for Payer: BCN Commercial |
$22,356.55
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$28,836.00
|
| Rate for Payer: Healthscope Whirlpool |
$27,970.92
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,510.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,185.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION
|
Facility
IP
|
$582.19
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
31310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$407.53 |
| Max. Negotiated Rate |
$582.19 |
| Rate for Payer: Aetna Commercial |
$523.97
|
| Rate for Payer: Aetna Commercial |
$524.02
|
| Rate for Payer: ASR ASR |
$564.77
|
| Rate for Payer: ASR ASR |
$564.72
|
| Rate for Payer: BCBS Trust/PPO |
$451.37
|
| Rate for Payer: BCBS Trust/PPO |
$451.41
|
| Rate for Payer: BCN Commercial |
$451.41
|
| Rate for Payer: BCN Commercial |
$451.37
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.79
|
| Rate for Payer: Cofinity Commercial |
$547.26
|
| Rate for Payer: Cofinity Commercial |
$547.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.75
|
| Rate for Payer: Healthscope Commercial |
$582.24
|
| Rate for Payer: Healthscope Commercial |
$582.19
|
| Rate for Payer: Healthscope Whirlpool |
$564.77
|
| Rate for Payer: Healthscope Whirlpool |
$564.72
|
| Rate for Payer: Mclaren Commercial |
$524.02
|
| Rate for Payer: Mclaren Commercial |
$523.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$494.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$494.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$407.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$407.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$512.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$512.37
|
|
|
ALTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,092.60 |
| Max. Negotiated Rate |
$14,418.00 |
| Rate for Payer: Aetna Commercial |
$12,976.20
|
| Rate for Payer: ASR ASR |
$13,985.46
|
| Rate for Payer: BCBS Trust/PPO |
$11,178.28
|
| Rate for Payer: BCN Commercial |
$11,178.28
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Commercial |
$13,552.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Healthscope Commercial |
$14,418.00
|
| Rate for Payer: Healthscope Whirlpool |
$13,985.46
|
| Rate for Payer: Mclaren Commercial |
$12,976.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,255.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,092.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,687.84
|
|
|
ALTEPLASE INFUSION FOR CARDIAC ARREST
|
Facility
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
300766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20,185.20 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: BCBS Trust/PPO |
$22,356.55
|
| Rate for Payer: BCN Commercial |
$22,356.55
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$28,836.00
|
| Rate for Payer: Healthscope Whirlpool |
$27,970.92
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,510.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,185.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
IP
|
$13.23
|
|
|
Service Code
|
NDC 66689-060-01
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$13.23 |
| Rate for Payer: Aetna Commercial |
$11.91
|
| Rate for Payer: ASR ASR |
$12.83
|
| Rate for Payer: BCBS Trust/PPO |
$10.26
|
| Rate for Payer: BCN Commercial |
$10.26
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$12.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$13.23
|
| Rate for Payer: Healthscope Whirlpool |
$12.83
|
| Rate for Payer: Mclaren Commercial |
$11.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.64
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
IP
|
$13.23
|
|
|
Service Code
|
NDC 66689-060-99
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$13.23 |
| Rate for Payer: Aetna Commercial |
$11.91
|
| Rate for Payer: ASR ASR |
$12.83
|
| Rate for Payer: BCBS Trust/PPO |
$10.26
|
| Rate for Payer: BCN Commercial |
$10.26
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$12.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$13.23
|
| Rate for Payer: Healthscope Whirlpool |
$12.83
|
| Rate for Payer: Mclaren Commercial |
$11.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.64
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
IP
|
$10.26
|
|
|
Service Code
|
NDC 0904-6838-73
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Aetna Commercial |
$9.23
|
| Rate for Payer: ASR ASR |
$9.95
|
| Rate for Payer: BCBS Trust/PPO |
$7.95
|
| Rate for Payer: BCN Commercial |
$7.95
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Commercial |
$9.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$10.26
|
| Rate for Payer: Healthscope Whirlpool |
$9.95
|
| Rate for Payer: Mclaren Commercial |
$9.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.03
|
|
|
AMANTADINE HCL 100 MG TABLET
|
Facility
IP
|
$361.95
|
|
|
Service Code
|
NDC 0832-0111-00
|
| Hospital Charge Code |
20506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.36 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna Commercial |
$325.76
|
| Rate for Payer: ASR ASR |
$351.09
|
| Rate for Payer: BCBS Trust/PPO |
$280.62
|
| Rate for Payer: BCN Commercial |
$280.62
|
| Rate for Payer: Cash Price |
$289.56
|
| Rate for Payer: Cofinity Commercial |
$340.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.56
|
| Rate for Payer: Healthscope Commercial |
$361.95
|
| Rate for Payer: Healthscope Whirlpool |
$351.09
|
| Rate for Payer: Mclaren Commercial |
$325.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$307.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$318.52
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$159.79
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.85 |
| Max. Negotiated Rate |
$159.79 |
| Rate for Payer: Aetna Commercial |
$143.81
|
| Rate for Payer: ASR ASR |
$155.00
|
| Rate for Payer: BCBS Trust/PPO |
$123.89
|
| Rate for Payer: BCN Commercial |
$123.89
|
| Rate for Payer: Cash Price |
$127.83
|
| Rate for Payer: Cofinity Commercial |
$150.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.83
|
| Rate for Payer: Healthscope Commercial |
$159.79
|
| Rate for Payer: Healthscope Whirlpool |
$155.00
|
| Rate for Payer: Mclaren Commercial |
$143.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.62
|
|
|
AMINOPHYLLINE 500 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$31.59
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
113386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$31.59 |
| Rate for Payer: Aetna Commercial |
$28.43
|
| Rate for Payer: ASR ASR |
$30.64
|
| Rate for Payer: BCBS Trust/PPO |
$24.49
|
| Rate for Payer: BCN Commercial |
$24.49
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Cofinity Commercial |
$29.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.27
|
| Rate for Payer: Healthscope Commercial |
$31.59
|
| Rate for Payer: Healthscope Whirlpool |
$30.64
|
| Rate for Payer: Mclaren Commercial |
$28.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.80
|
|
