|
LORAZEPAM 2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$164.84
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
10467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.39 |
| Max. Negotiated Rate |
$164.84 |
| Rate for Payer: Aetna Commercial |
$148.36
|
| Rate for Payer: Aetna Commercial |
$25.62
|
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Commercial |
$19.04
|
| Rate for Payer: Aetna Commercial |
$27.97
|
| Rate for Payer: ASR ASR |
$17.69
|
| Rate for Payer: ASR ASR |
$30.15
|
| Rate for Payer: ASR ASR |
$159.89
|
| Rate for Payer: ASR ASR |
$27.62
|
| Rate for Payer: ASR ASR |
$20.53
|
| Rate for Payer: BCBS Trust/PPO |
$22.07
|
| Rate for Payer: BCBS Trust/PPO |
$16.41
|
| Rate for Payer: BCBS Trust/PPO |
$24.10
|
| Rate for Payer: BCBS Trust/PPO |
$127.80
|
| Rate for Payer: BCBS Trust/PPO |
$14.14
|
| Rate for Payer: BCN Commercial |
$22.07
|
| Rate for Payer: BCN Commercial |
$127.80
|
| Rate for Payer: BCN Commercial |
$24.10
|
| Rate for Payer: BCN Commercial |
$14.14
|
| Rate for Payer: BCN Commercial |
$16.41
|
| Rate for Payer: Cash Price |
$131.87
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$24.86
|
| Rate for Payer: Cash Price |
$14.59
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cofinity Commercial |
$29.22
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$26.76
|
| Rate for Payer: Cofinity Commercial |
$154.95
|
| Rate for Payer: Cofinity Commercial |
$17.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.93
|
| Rate for Payer: Healthscope Commercial |
$21.16
|
| Rate for Payer: Healthscope Commercial |
$164.84
|
| Rate for Payer: Healthscope Commercial |
$18.24
|
| Rate for Payer: Healthscope Commercial |
$28.47
|
| Rate for Payer: Healthscope Commercial |
$31.08
|
| Rate for Payer: Healthscope Whirlpool |
$30.15
|
| Rate for Payer: Healthscope Whirlpool |
$159.89
|
| Rate for Payer: Healthscope Whirlpool |
$20.53
|
| Rate for Payer: Healthscope Whirlpool |
$27.62
|
| Rate for Payer: Healthscope Whirlpool |
$17.69
|
| Rate for Payer: Mclaren Commercial |
$25.62
|
| Rate for Payer: Mclaren Commercial |
$16.42
|
| Rate for Payer: Mclaren Commercial |
$148.36
|
| Rate for Payer: Mclaren Commercial |
$27.97
|
| Rate for Payer: Mclaren Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.62
|
|
|
LORAZEPAM 2 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$16.53
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
112180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$16.53 |
| Rate for Payer: Aetna Commercial |
$14.88
|
| Rate for Payer: ASR ASR |
$16.03
|
| Rate for Payer: BCBS Trust/PPO |
$12.82
|
| Rate for Payer: BCN Commercial |
$12.82
|
| Rate for Payer: Cash Price |
$13.23
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.22
|
| Rate for Payer: Healthscope Commercial |
$16.53
|
| Rate for Payer: Healthscope Whirlpool |
$16.03
|
| Rate for Payer: Mclaren Commercial |
$14.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.55
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 0781-5700-92
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.46 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$247.46
|
| Rate for Payer: ASR ASR |
$266.70
|
| Rate for Payer: BCBS Trust/PPO |
$213.17
|
| Rate for Payer: BCN Commercial |
$213.17
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$258.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Healthscope Whirlpool |
$266.70
|
| Rate for Payer: Mclaren Commercial |
$247.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.96
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 68084-347-11
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.60 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Aetna Commercial |
$202.64
|
| Rate for Payer: ASR ASR |
$218.40
|
| Rate for Payer: BCBS Trust/PPO |
$174.56
|
| Rate for Payer: BCN Commercial |
$174.56
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$211.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$225.15
|
| Rate for Payer: Healthscope Whirlpool |
$218.40
|
| Rate for Payer: Mclaren Commercial |
$202.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.13
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 0904-7048-61
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.60 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Aetna Commercial |
$202.64
|
| Rate for Payer: ASR ASR |
$218.40
|
| Rate for Payer: BCBS Trust/PPO |
$174.56
|
| Rate for Payer: BCN Commercial |
$174.56
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$211.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$225.15
|
| Rate for Payer: Healthscope Whirlpool |
$218.40
|
| Rate for Payer: Mclaren Commercial |
$202.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.13
|
|
|
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC
|
Facility
|
IP
|
$30,837.83
|
|
|
Service Code
|
MS-DRG 493
|
| Min. Negotiated Rate |
$20,913.96 |
| Max. Negotiated Rate |
$30,837.83 |
| Rate for Payer: Aetna Medicare |
$22,014.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,518.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,518.36
|
| Rate for Payer: BCBS MAPPO |
$22,014.69
|
| Rate for Payer: BCN Medicare Advantage |
$22,014.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,014.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$22,014.69
|
| Rate for Payer: Mclaren Medicare |
$22,014.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23,115.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,316.89
|
| Rate for Payer: PACE Medicare |
$20,913.96
|
| Rate for Payer: PACE SWMI |
$22,014.69
|
| Rate for Payer: PHP Commercial |
$24,216.16
|
| Rate for Payer: PHP Medicare Advantage |
$22,014.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,837.83
|
| Rate for Payer: Priority Health Medicare |
$22,014.69
|
| Rate for Payer: Priority Health Narrow Network |
$24,670.26
|
| Rate for Payer: Railroad Medicare Medicare |
$22,014.69
|
| Rate for Payer: UHC Medicare Advantage |
$22,675.13
|
| Rate for Payer: VA VA |
$22,014.69
|
|
|
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC
|
Facility
|
IP
|
$44,453.36
|
|
|
Service Code
|
MS-DRG 492
|
| Min. Negotiated Rate |
$29,442.82 |
| Max. Negotiated Rate |
$44,453.36 |
| Rate for Payer: Aetna Medicare |
$30,992.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,740.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,740.55
|
| Rate for Payer: BCBS MAPPO |
$30,992.44
|
| Rate for Payer: BCN Medicare Advantage |
$30,992.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,992.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$30,992.44
|
| Rate for Payer: Mclaren Medicare |
$30,992.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32,542.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,641.31
|
| Rate for Payer: PACE Medicare |
$29,442.82
|
| Rate for Payer: PACE SWMI |
$30,992.44
|
| Rate for Payer: PHP Commercial |
$34,091.68
|
| Rate for Payer: PHP Medicare Advantage |
$30,992.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44,453.36
|
| Rate for Payer: Priority Health Medicare |
$30,992.44
|
| Rate for Payer: Priority Health Narrow Network |
$35,562.69
|
| Rate for Payer: Railroad Medicare Medicare |
$30,992.44
|
| Rate for Payer: UHC Medicare Advantage |
$31,922.21
|
| Rate for Payer: VA VA |
$30,992.44
|
|
|
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC
|
Facility
|
IP
|
$24,000.53
|
|
|
Service Code
|
MS-DRG 494
|
| Min. Negotiated Rate |
$16,631.01 |
| Max. Negotiated Rate |
$24,000.53 |
| Rate for Payer: Aetna Medicare |
$17,506.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,882.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,882.91
|
| Rate for Payer: BCBS MAPPO |
$17,506.33
|
| Rate for Payer: BCN Medicare Advantage |
$17,506.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,506.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,506.33
|
| Rate for Payer: Mclaren Medicare |
$17,506.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,381.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,132.28
|
| Rate for Payer: PACE Medicare |
$16,631.01
|
| Rate for Payer: PACE SWMI |
$17,506.33
|
| Rate for Payer: PHP Commercial |
$19,256.96
|
| Rate for Payer: PHP Medicare Advantage |
$17,506.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,000.53
|
| Rate for Payer: Priority Health Medicare |
$17,506.33
|
| Rate for Payer: Priority Health Narrow Network |
$19,200.42
|
| Rate for Payer: Railroad Medicare Medicare |
$17,506.33
|
| Rate for Payer: UHC Medicare Advantage |
$18,031.52
|
| Rate for Payer: VA VA |
$17,506.33
|
|
|
LUNG TRANSPLANT
|
Facility
|
IP
|
$157,500.58
|
|
|
Service Code
|
MS-DRG 007
|
| Min. Negotiated Rate |
$100,256.48 |
| Max. Negotiated Rate |
$157,500.58 |
| Rate for Payer: Aetna Medicare |
$105,533.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131,916.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131,916.42
|
| Rate for Payer: BCBS MAPPO |
$105,533.14
|
| Rate for Payer: BCN Medicare Advantage |
$105,533.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105,533.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$105,533.14
|
| Rate for Payer: Mclaren Medicare |
$105,533.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$110,809.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121,363.11
|
| Rate for Payer: PACE Medicare |
$100,256.48
|
| Rate for Payer: PACE SWMI |
$105,533.14
|
| Rate for Payer: PHP Commercial |
$116,086.45
|
| Rate for Payer: PHP Medicare Advantage |
$105,533.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157,500.58
|
| Rate for Payer: Priority Health Medicare |
$105,533.14
|
| Rate for Payer: Priority Health Narrow Network |
$126,000.46
|
| Rate for Payer: Railroad Medicare Medicare |
$105,533.14
|
| Rate for Payer: UHC Medicare Advantage |
$108,699.13
|
| Rate for Payer: VA VA |
$105,533.14
|
|
|
LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$10,077.34
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,054.14 |
| Max. Negotiated Rate |
$10,077.34 |
| Rate for Payer: Aetna Commercial |
$9,069.61
|
| Rate for Payer: ASR ASR |
$9,775.02
|
| Rate for Payer: BCBS Trust/PPO |
$7,812.96
|
| Rate for Payer: BCN Commercial |
$7,812.96
|
| Rate for Payer: Cash Price |
$8,061.87
|
| Rate for Payer: Cofinity Commercial |
$9,472.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,061.87
|
| Rate for Payer: Healthscope Commercial |
$10,077.34
|
| Rate for Payer: Healthscope Whirlpool |
$9,775.02
|
| Rate for Payer: Mclaren Commercial |
$9,069.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,565.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,054.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,868.06
|
|
|
LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$30,231.94
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21,162.36 |
| Max. Negotiated Rate |
$30,231.94 |
| Rate for Payer: Aetna Commercial |
$27,208.75
|
| Rate for Payer: ASR ASR |
$29,324.98
|
| Rate for Payer: BCBS Trust/PPO |
$23,438.82
|
| Rate for Payer: BCN Commercial |
$23,438.82
|
| Rate for Payer: Cash Price |
$24,185.55
|
| Rate for Payer: Cofinity Commercial |
$28,418.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,185.55
|
| Rate for Payer: Healthscope Commercial |
$30,231.94
|
| Rate for Payer: Healthscope Whirlpool |
$29,324.98
|
| Rate for Payer: Mclaren Commercial |
$27,208.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25,697.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21,162.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26,604.11
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$28,660.16
|
|
|
Service Code
|
MS-DRG 821
|
| Min. Negotiated Rate |
$19,549.85 |
| Max. Negotiated Rate |
$28,660.16 |
| Rate for Payer: Aetna Medicare |
$20,578.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,723.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,723.49
|
| Rate for Payer: BCBS MAPPO |
$20,578.79
|
| Rate for Payer: BCN Medicare Advantage |
$20,578.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,578.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$20,578.79
|
| Rate for Payer: Mclaren Medicare |
$20,578.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,607.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,665.61
|
| Rate for Payer: PACE Medicare |
$19,549.85
|
| Rate for Payer: PACE SWMI |
$20,578.79
|
| Rate for Payer: PHP Commercial |
$22,636.67
|
| Rate for Payer: PHP Medicare Advantage |
$20,578.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,660.16
|
| Rate for Payer: Priority Health Medicare |
$20,578.79
|
| Rate for Payer: Priority Health Narrow Network |
$22,928.13
|
| Rate for Payer: Railroad Medicare Medicare |
$20,578.79
|
| Rate for Payer: UHC Medicare Advantage |
$21,196.15
|
| Rate for Payer: VA VA |
$20,578.79
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$77,639.63
|
|
|
Service Code
|
MS-DRG 820
|
| Min. Negotiated Rate |
$50,230.96 |
| Max. Negotiated Rate |
$77,639.63 |
| Rate for Payer: Aetna Medicare |
$52,874.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66,093.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66,093.36
|
| Rate for Payer: BCBS MAPPO |
$52,874.69
|
| Rate for Payer: BCN Medicare Advantage |
$52,874.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52,874.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$52,874.69
|
| Rate for Payer: Mclaren Medicare |
$52,874.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$55,518.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60,805.89
|
| Rate for Payer: PACE Medicare |
$50,230.96
|
| Rate for Payer: PACE SWMI |
$52,874.69
|
| Rate for Payer: PHP Commercial |
$58,162.16
|
| Rate for Payer: PHP Medicare Advantage |
$52,874.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77,639.63
|
| Rate for Payer: Priority Health Medicare |
$52,874.69
|
| Rate for Payer: Priority Health Narrow Network |
$62,111.70
|
| Rate for Payer: Railroad Medicare Medicare |
$52,874.69
|
| Rate for Payer: UHC Medicare Advantage |
$54,460.93
|
| Rate for Payer: VA VA |
$52,874.69
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$15,906.19
|
|
|
Service Code
|
MS-DRG 822
|
| Min. Negotiated Rate |
$11,560.65 |
| Max. Negotiated Rate |
$15,906.19 |
| Rate for Payer: Aetna Medicare |
$12,169.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,211.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,211.39
|
| Rate for Payer: BCBS MAPPO |
$12,169.11
|
| Rate for Payer: BCN Medicare Advantage |
$12,169.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,169.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,169.11
|
| Rate for Payer: Mclaren Medicare |
$12,169.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,777.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,994.48
|
| Rate for Payer: PACE Medicare |
$11,560.65
|
| Rate for Payer: PACE SWMI |
$12,169.11
|
| Rate for Payer: PHP Commercial |
$13,386.02
|
| Rate for Payer: PHP Medicare Advantage |
$12,169.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,906.19
|
| Rate for Payer: Priority Health Medicare |
$12,169.11
|
| Rate for Payer: Priority Health Narrow Network |
$12,724.95
|
| Rate for Payer: Railroad Medicare Medicare |
$12,169.11
|
| Rate for Payer: UHC Medicare Advantage |
$12,534.18
|
| Rate for Payer: VA VA |
$12,169.11
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC
|
Facility
|
IP
|
$20,203.74
|
|
|
Service Code
|
MS-DRG 841
|
| Min. Negotiated Rate |
$14,252.67 |
| Max. Negotiated Rate |
$20,203.74 |
| Rate for Payer: Aetna Medicare |
$15,002.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,753.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,753.51
|
| Rate for Payer: BCBS MAPPO |
$15,002.81
|
| Rate for Payer: BCN Medicare Advantage |
$15,002.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,002.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,002.81
|
| Rate for Payer: Mclaren Medicare |
$15,002.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,752.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,253.23
|
| Rate for Payer: PACE Medicare |
$14,252.67
|
| Rate for Payer: PACE SWMI |
$15,002.81
|
| Rate for Payer: PHP Commercial |
$16,503.09
|
| Rate for Payer: PHP Medicare Advantage |
$15,002.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,203.74
|
| Rate for Payer: Priority Health Medicare |
$15,002.81
|
| Rate for Payer: Priority Health Narrow Network |
$16,162.99
|
| Rate for Payer: Railroad Medicare Medicare |
$15,002.81
|
| Rate for Payer: UHC Medicare Advantage |
$15,452.89
|
| Rate for Payer: VA VA |
$15,002.81
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC
|
Facility
|
IP
|
$40,127.57
|
|
|
Service Code
|
MS-DRG 840
|
| Min. Negotiated Rate |
$26,733.10 |
| Max. Negotiated Rate |
$40,127.57 |
| Rate for Payer: Aetna Medicare |
$28,140.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,175.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,175.14
|
| Rate for Payer: BCBS MAPPO |
$28,140.11
|
| Rate for Payer: BCN Medicare Advantage |
$28,140.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,140.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$28,140.11
|
| Rate for Payer: Mclaren Medicare |
$28,140.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29,547.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,361.13
|
| Rate for Payer: PACE Medicare |
$26,733.10
|
| Rate for Payer: PACE SWMI |
$28,140.11
|
| Rate for Payer: PHP Commercial |
$30,954.12
|
| Rate for Payer: PHP Medicare Advantage |
$28,140.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40,127.57
|
| Rate for Payer: Priority Health Medicare |
$28,140.11
|
| Rate for Payer: Priority Health Narrow Network |
$32,102.06
|
| Rate for Payer: Railroad Medicare Medicare |
$28,140.11
|
| Rate for Payer: UHC Medicare Advantage |
$28,984.31
|
| Rate for Payer: VA VA |
$28,140.11
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC
|
Facility
|
IP
|
$28,670.44
|
|
|
Service Code
|
MS-DRG 824
|
| Min. Negotiated Rate |
$19,556.27 |
| Max. Negotiated Rate |
$28,670.44 |
| Rate for Payer: Aetna Medicare |
$20,585.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,731.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,731.94
|
| Rate for Payer: BCBS MAPPO |
$20,585.55
|
| Rate for Payer: BCN Medicare Advantage |
$20,585.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,585.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$20,585.55
|
| Rate for Payer: Mclaren Medicare |
$20,585.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,614.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,673.38
|
| Rate for Payer: PACE Medicare |
$19,556.27
|
| Rate for Payer: PACE SWMI |
$20,585.55
|
| Rate for Payer: PHP Commercial |
$22,644.10
|
| Rate for Payer: PHP Medicare Advantage |
$20,585.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,670.44
|
| Rate for Payer: Priority Health Medicare |
$20,585.55
|
| Rate for Payer: Priority Health Narrow Network |
$22,936.35
|
| Rate for Payer: Railroad Medicare Medicare |
$20,585.55
|
| Rate for Payer: UHC Medicare Advantage |
$21,203.12
|
| Rate for Payer: VA VA |
$20,585.55
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC
|
Facility
|
IP
|
$57,804.40
|
|
|
Service Code
|
MS-DRG 823
|
| Min. Negotiated Rate |
$37,806.01 |
| Max. Negotiated Rate |
$57,804.40 |
| Rate for Payer: Aetna Medicare |
$39,795.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49,744.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49,744.75
|
| Rate for Payer: BCBS MAPPO |
$39,795.80
|
| Rate for Payer: BCN Medicare Advantage |
$39,795.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39,795.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$39,795.80
|
| Rate for Payer: Mclaren Medicare |
$39,795.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41,785.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45,765.17
|
| Rate for Payer: PACE Medicare |
$37,806.01
|
| Rate for Payer: PACE SWMI |
$39,795.80
|
| Rate for Payer: PHP Commercial |
$43,775.38
|
| Rate for Payer: PHP Medicare Advantage |
$39,795.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57,804.40
|
| Rate for Payer: Priority Health Medicare |
$39,795.80
|
| Rate for Payer: Priority Health Narrow Network |
$46,243.52
|
| Rate for Payer: Railroad Medicare Medicare |
$39,795.80
|
| Rate for Payer: UHC Medicare Advantage |
$40,989.67
|
| Rate for Payer: VA VA |
$39,795.80
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$16,581.58
|
|
|
Service Code
|
MS-DRG 825
|
| Min. Negotiated Rate |
$11,983.72 |
| Max. Negotiated Rate |
$16,581.58 |
| Rate for Payer: Aetna Medicare |
$12,614.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,768.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,768.05
|
| Rate for Payer: BCBS MAPPO |
$12,614.44
|
| Rate for Payer: BCN Medicare Advantage |
$12,614.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,614.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,614.44
|
| Rate for Payer: Mclaren Medicare |
$12,614.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,245.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,506.61
|
| Rate for Payer: PACE Medicare |
$11,983.72
|
| Rate for Payer: PACE SWMI |
$12,614.44
|
| Rate for Payer: PHP Commercial |
$13,875.88
|
| Rate for Payer: PHP Medicare Advantage |
$12,614.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,581.58
|
| Rate for Payer: Priority Health Medicare |
$12,614.44
|
| Rate for Payer: Priority Health Narrow Network |
$13,265.26
|
| Rate for Payer: Railroad Medicare Medicare |
$12,614.44
|
| Rate for Payer: UHC Medicare Advantage |
$12,992.87
|
| Rate for Payer: VA VA |
$12,614.44
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC
|
Facility
|
IP
|
$13,692.58
|
|
|
Service Code
|
MS-DRG 842
|
| Min. Negotiated Rate |
$10,174.03 |
| Max. Negotiated Rate |
$13,692.58 |
| Rate for Payer: Aetna Medicare |
$10,709.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,386.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,386.89
|
| Rate for Payer: BCBS MAPPO |
$10,709.51
|
| Rate for Payer: BCN Medicare Advantage |
$10,709.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,709.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,709.51
|
| Rate for Payer: Mclaren Medicare |
$10,709.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,244.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,315.94
|
| Rate for Payer: PACE Medicare |
$10,174.03
|
| Rate for Payer: PACE SWMI |
$10,709.51
|
| Rate for Payer: PHP Commercial |
$11,780.46
|
| Rate for Payer: PHP Medicare Advantage |
$10,709.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,692.58
|
| Rate for Payer: Priority Health Medicare |
$10,709.51
|
| Rate for Payer: Priority Health Narrow Network |
$10,954.06
|
| Rate for Payer: Railroad Medicare Medicare |
$10,709.51
|
| Rate for Payer: UHC Medicare Advantage |
$11,030.80
|
| Rate for Payer: VA VA |
$10,709.51
|
|
|
LYSINE HCL 500 MG TABLET
|
Facility
|
IP
|
$68.15
|
|
|
Service Code
|
NDC 9629513583
|
| Hospital Charge Code |
119069
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.70 |
| Max. Negotiated Rate |
$68.15 |
| Rate for Payer: Aetna Commercial |
$61.34
|
| Rate for Payer: ASR ASR |
$66.11
|
| Rate for Payer: BCBS Trust/PPO |
$52.84
|
| Rate for Payer: BCN Commercial |
$52.84
|
| Rate for Payer: Cash Price |
$54.52
|
| Rate for Payer: Cofinity Commercial |
$64.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.52
|
| Rate for Payer: Healthscope Commercial |
$68.15
|
| Rate for Payer: Healthscope Whirlpool |
$66.11
|
| Rate for Payer: Mclaren Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.97
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$0.70
|
|
|
Service Code
|
NDC 9900-0003-40
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Aetna Commercial |
$0.63
|
| Rate for Payer: ASR ASR |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$0.54
|
| Rate for Payer: BCN Commercial |
$0.54
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cofinity Commercial |
$0.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.56
|
| Rate for Payer: Healthscope Commercial |
$0.70
|
| Rate for Payer: Healthscope Whirlpool |
$0.68
|
| Rate for Payer: Mclaren Commercial |
$0.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.62
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$10.50
|
|
|
Service Code
|
NDC 0904-0788-16
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: ASR ASR |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$8.14
|
| Rate for Payer: BCN Commercial |
$8.14
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$9.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.40
|
| Rate for Payer: Healthscope Commercial |
$10.50
|
| Rate for Payer: Healthscope Whirlpool |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$9.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.24
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$1.45
|
|
|
Service Code
|
NDC 6498033990
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Aetna Commercial |
$1.30
|
| Rate for Payer: ASR ASR |
$1.41
|
| Rate for Payer: BCBS Trust/PPO |
$1.12
|
| Rate for Payer: BCN Commercial |
$1.12
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cofinity Commercial |
$1.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.16
|
| Rate for Payer: Healthscope Commercial |
$1.45
|
| Rate for Payer: Healthscope Whirlpool |
$1.41
|
| Rate for Payer: Mclaren Commercial |
$1.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.28
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$145.20
|
|
|
Service Code
|
NDC 6498033901
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.64 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Aetna Commercial |
$130.68
|
| Rate for Payer: ASR ASR |
$140.84
|
| Rate for Payer: BCBS Trust/PPO |
$112.57
|
| Rate for Payer: BCN Commercial |
$112.57
|
| Rate for Payer: Cash Price |
$116.16
|
| Rate for Payer: Cofinity Commercial |
$136.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.16
|
| Rate for Payer: Healthscope Commercial |
$145.20
|
| Rate for Payer: Healthscope Whirlpool |
$140.84
|
| Rate for Payer: Mclaren Commercial |
$130.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.78
|
|
