|
NALOXONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$57.94
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
5374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$57.94 |
| Rate for Payer: Aetna Commercial |
$52.15
|
| Rate for Payer: Aetna Commercial |
$42.41
|
| Rate for Payer: Aetna Commercial |
$78.22
|
| Rate for Payer: ASR ASR |
$84.30
|
| Rate for Payer: ASR ASR |
$45.71
|
| Rate for Payer: ASR ASR |
$56.20
|
| Rate for Payer: BCBS Trust/PPO |
$44.92
|
| Rate for Payer: BCBS Trust/PPO |
$67.38
|
| Rate for Payer: BCBS Trust/PPO |
$36.53
|
| Rate for Payer: BCN Commercial |
$67.38
|
| Rate for Payer: BCN Commercial |
$36.53
|
| Rate for Payer: BCN Commercial |
$44.92
|
| Rate for Payer: Cash Price |
$37.69
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Cofinity Commercial |
$54.46
|
| Rate for Payer: Cofinity Commercial |
$44.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.35
|
| Rate for Payer: Healthscope Commercial |
$86.91
|
| Rate for Payer: Healthscope Commercial |
$57.94
|
| Rate for Payer: Healthscope Commercial |
$47.12
|
| Rate for Payer: Healthscope Whirlpool |
$45.71
|
| Rate for Payer: Healthscope Whirlpool |
$56.20
|
| Rate for Payer: Healthscope Whirlpool |
$84.30
|
| Rate for Payer: Mclaren Commercial |
$78.22
|
| Rate for Payer: Mclaren Commercial |
$52.15
|
| Rate for Payer: Mclaren Commercial |
$42.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.48
|
|
|
NALTREXONE ER 380 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE
|
Facility
|
IP
|
$4,883.94
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
76527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,418.76 |
| Max. Negotiated Rate |
$4,883.94 |
| Rate for Payer: Aetna Commercial |
$4,395.55
|
| Rate for Payer: ASR ASR |
$4,737.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,786.52
|
| Rate for Payer: BCN Commercial |
$3,786.52
|
| Rate for Payer: Cash Price |
$3,907.15
|
| Rate for Payer: Cofinity Commercial |
$4,590.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,907.15
|
| Rate for Payer: Healthscope Commercial |
$4,883.94
|
| Rate for Payer: Healthscope Whirlpool |
$4,737.42
|
| Rate for Payer: Mclaren Commercial |
$4,395.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,151.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,418.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,297.87
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$209.15
|
|
|
Service Code
|
NDC 50268-594-15
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$209.15 |
| Rate for Payer: Aetna Commercial |
$188.24
|
| Rate for Payer: ASR ASR |
$202.88
|
| Rate for Payer: BCBS Trust/PPO |
$162.15
|
| Rate for Payer: BCN Commercial |
$162.15
|
| Rate for Payer: Cash Price |
$167.32
|
| Rate for Payer: Cofinity Commercial |
$196.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.32
|
| Rate for Payer: Healthscope Commercial |
$209.15
|
| Rate for Payer: Healthscope Whirlpool |
$202.88
|
| Rate for Payer: Mclaren Commercial |
$188.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.05
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$4.18
|
|
|
Service Code
|
NDC 50268-594-11
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: ASR ASR |
$4.05
|
| Rate for Payer: BCBS Trust/PPO |
$3.24
|
| Rate for Payer: BCN Commercial |
$3.24
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cofinity Commercial |
$3.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Healthscope Whirlpool |
$4.05
|
| Rate for Payer: Mclaren Commercial |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.68
|
|
|
NASAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
IP
|
$3.19
|
|
|
Service Code
|
NDC 9900-0004-01
|
| Hospital Charge Code |
169209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: ASR ASR |
$3.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.47
|
| Rate for Payer: BCN Commercial |
$2.47
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cofinity Commercial |
$3.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.55
|
| Rate for Payer: Healthscope Commercial |
$3.19
|
| Rate for Payer: Healthscope Whirlpool |
$3.09
|
| Rate for Payer: Mclaren Commercial |
$2.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.81
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS
|
Facility
|
IP
|
$153.76
|
|
|
Service Code
|
NDC 24208-790-62
|
| Hospital Charge Code |
5474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.63 |
| Max. Negotiated Rate |
$153.76 |
| Rate for Payer: Aetna Commercial |
$138.38
|
| Rate for Payer: ASR ASR |
$149.15
|
| Rate for Payer: BCBS Trust/PPO |
$119.21
|
| Rate for Payer: BCN Commercial |
$119.21
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cofinity Commercial |
$144.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.01
|
| Rate for Payer: Healthscope Commercial |
$153.76
|
| Rate for Payer: Healthscope Whirlpool |
$149.15
|
| Rate for Payer: Mclaren Commercial |
$138.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.31
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$41.33
|
|
|
Service Code
|
NDC 0574-4160-35
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$41.33 |
| Rate for Payer: Aetna Commercial |
$37.20
|
| Rate for Payer: ASR ASR |
$40.09
|
| Rate for Payer: BCBS Trust/PPO |
$32.04
|
| Rate for Payer: BCN Commercial |
$32.04
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cofinity Commercial |
$38.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.06
|
| Rate for Payer: Healthscope Commercial |
$41.33
|
| Rate for Payer: Healthscope Whirlpool |
$40.09
|
| Rate for Payer: Mclaren Commercial |
$37.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.37
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$45.81
|
|
|
Service Code
|
NDC 24208-795-35
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.07 |
| Max. Negotiated Rate |
$45.81 |
| Rate for Payer: Aetna Commercial |
$41.23
|
| Rate for Payer: ASR ASR |
$44.44
|
| Rate for Payer: BCBS Trust/PPO |
$35.52
|
| Rate for Payer: BCN Commercial |
$35.52
|
| Rate for Payer: Cash Price |
$36.65
|
| Rate for Payer: Cofinity Commercial |
$43.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.65
|
| Rate for Payer: Healthscope Commercial |
$45.81
|
| Rate for Payer: Healthscope Whirlpool |
$44.44
|
| Rate for Payer: Mclaren Commercial |
$41.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.31
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$58.59
|
|
|
Service Code
|
NDC 61314-631-36
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.01 |
| Max. Negotiated Rate |
$58.59 |
| Rate for Payer: Aetna Commercial |
$52.73
|
| Rate for Payer: ASR ASR |
$56.83
|
| Rate for Payer: BCBS Trust/PPO |
$45.42
|
| Rate for Payer: BCN Commercial |
$45.42
|
| Rate for Payer: Cash Price |
$46.87
|
| Rate for Payer: Cofinity Commercial |
$55.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.87
|
| Rate for Payer: Healthscope Commercial |
$58.59
|
| Rate for Payer: Healthscope Whirlpool |
$56.83
|
| Rate for Payer: Mclaren Commercial |
$52.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.56
|
|
|
NEOMYCIN-BACITRACIN-POLY-HC 3.5 MG-400-10,000 UNIT/G-1 % EYE OINTMENT
|
Facility
|
IP
|
$60.69
|
|
|
Service Code
|
NDC 24208-785-55
|
| Hospital Charge Code |
849
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.48 |
| Max. Negotiated Rate |
$60.69 |
| Rate for Payer: Aetna Commercial |
$54.62
|
| Rate for Payer: ASR ASR |
$58.87
|
| Rate for Payer: BCBS Trust/PPO |
$47.05
|
| Rate for Payer: BCN Commercial |
$47.05
|
| Rate for Payer: Cash Price |
$48.55
|
| Rate for Payer: Cofinity Commercial |
$57.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.55
|
| Rate for Payer: Healthscope Commercial |
$60.69
|
| Rate for Payer: Healthscope Whirlpool |
$58.87
|
| Rate for Payer: Mclaren Commercial |
$54.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.41
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$9.45
|
|
|
Service Code
|
NDC 0904-0734-31
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: ASR ASR |
$9.17
|
| Rate for Payer: BCBS Trust/PPO |
$7.33
|
| Rate for Payer: BCN Commercial |
$7.33
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$9.45
|
| Rate for Payer: Healthscope Whirlpool |
$9.17
|
| Rate for Payer: Mclaren Commercial |
$8.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.32
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$12.15
|
|
|
Service Code
|
NDC 0713-0268-31
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna Commercial |
$10.94
|
| Rate for Payer: ASR ASR |
$11.79
|
| Rate for Payer: BCBS Trust/PPO |
$9.42
|
| Rate for Payer: BCN Commercial |
$9.42
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cofinity Commercial |
$11.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Healthscope Whirlpool |
$11.79
|
| Rate for Payer: Mclaren Commercial |
$10.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.69
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
IP
|
$368.86
|
|
|
Service Code
|
NDC 0904-8805-67
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$258.20 |
| Max. Negotiated Rate |
$368.86 |
| Rate for Payer: Aetna Commercial |
$331.97
|
| Rate for Payer: ASR ASR |
$357.79
|
| Rate for Payer: BCBS Trust/PPO |
$285.98
|
| Rate for Payer: BCN Commercial |
$285.98
|
| Rate for Payer: Cash Price |
$295.08
|
| Rate for Payer: Cofinity Commercial |
$346.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.09
|
| Rate for Payer: Healthscope Commercial |
$368.86
|
| Rate for Payer: Healthscope Whirlpool |
$357.79
|
| Rate for Payer: Mclaren Commercial |
$331.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$313.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$324.60
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
IP
|
$473.76
|
|
|
Service Code
|
NDC 47682-223-35
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$331.63 |
| Max. Negotiated Rate |
$473.76 |
| Rate for Payer: Aetna Commercial |
$426.38
|
| Rate for Payer: ASR ASR |
$459.55
|
| Rate for Payer: BCBS Trust/PPO |
$367.31
|
| Rate for Payer: BCN Commercial |
$367.31
|
| Rate for Payer: Cash Price |
$379.01
|
| Rate for Payer: Cofinity Commercial |
$445.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.01
|
| Rate for Payer: Healthscope Commercial |
$473.76
|
| Rate for Payer: Healthscope Whirlpool |
$459.55
|
| Rate for Payer: Mclaren Commercial |
$426.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$416.91
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
IP
|
$3.29
|
|
|
Service Code
|
NDC 47682-223-99
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: ASR ASR |
$3.19
|
| Rate for Payer: BCBS Trust/PPO |
$2.55
|
| Rate for Payer: BCN Commercial |
$2.55
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.63
|
| Rate for Payer: Healthscope Commercial |
$3.29
|
| Rate for Payer: Healthscope Whirlpool |
$3.19
|
| Rate for Payer: Mclaren Commercial |
$2.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.90
|
|
|
NEOMYCIN-COLIST-HC-THONZONM 3.3 MG-3 MG-10 MG-0.5 MG/ML EAR DROPS,SUSP
|
Facility
|
IP
|
$738.96
|
|
|
Service Code
|
NDC 63481-529-10
|
| Hospital Charge Code |
108037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$517.27 |
| Max. Negotiated Rate |
$738.96 |
| Rate for Payer: Aetna Commercial |
$665.06
|
| Rate for Payer: ASR ASR |
$716.79
|
| Rate for Payer: BCBS Trust/PPO |
$572.92
|
| Rate for Payer: BCN Commercial |
$572.92
|
| Rate for Payer: Cash Price |
$591.16
|
| Rate for Payer: Cofinity Commercial |
$694.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$591.17
|
| Rate for Payer: Healthscope Commercial |
$738.96
|
| Rate for Payer: Healthscope Whirlpool |
$716.79
|
| Rate for Payer: Mclaren Commercial |
$665.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$628.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$650.28
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
IP
|
$62.97
|
|
|
Service Code
|
NDC 61314-630-06
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$62.97 |
| Rate for Payer: Aetna Commercial |
$56.67
|
| Rate for Payer: ASR ASR |
$61.08
|
| Rate for Payer: BCBS Trust/PPO |
$48.82
|
| Rate for Payer: BCN Commercial |
$48.82
|
| Rate for Payer: Cash Price |
$50.37
|
| Rate for Payer: Cofinity Commercial |
$59.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.38
|
| Rate for Payer: Healthscope Commercial |
$62.97
|
| Rate for Payer: Healthscope Whirlpool |
$61.08
|
| Rate for Payer: Mclaren Commercial |
$56.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.41
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
IP
|
$44.27
|
|
|
Service Code
|
NDC 24208-830-60
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.99 |
| Max. Negotiated Rate |
$44.27 |
| Rate for Payer: Aetna Commercial |
$39.84
|
| Rate for Payer: ASR ASR |
$42.94
|
| Rate for Payer: BCBS Trust/PPO |
$34.32
|
| Rate for Payer: BCN Commercial |
$34.32
|
| Rate for Payer: Cash Price |
$35.42
|
| Rate for Payer: Cofinity Commercial |
$41.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.42
|
| Rate for Payer: Healthscope Commercial |
$44.27
|
| Rate for Payer: Healthscope Whirlpool |
$42.94
|
| Rate for Payer: Mclaren Commercial |
$39.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.96
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP
|
Facility
|
IP
|
$149.49
|
|
|
Service Code
|
NDC 24208-635-62
|
| Hospital Charge Code |
28810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.64 |
| Max. Negotiated Rate |
$149.49 |
| Rate for Payer: Aetna Commercial |
$134.54
|
| Rate for Payer: ASR ASR |
$145.01
|
| Rate for Payer: BCBS Trust/PPO |
$115.90
|
| Rate for Payer: BCN Commercial |
$115.90
|
| Rate for Payer: Cash Price |
$119.59
|
| Rate for Payer: Cofinity Commercial |
$140.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.59
|
| Rate for Payer: Healthscope Commercial |
$149.49
|
| Rate for Payer: Healthscope Whirlpool |
$145.01
|
| Rate for Payer: Mclaren Commercial |
$134.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.55
|
|
|
NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY
|
Facility
|
IP
|
$23,361.10
|
|
|
Service Code
|
MS-DRG 789
|
| Min. Negotiated Rate |
$16,230.46 |
| Max. Negotiated Rate |
$23,361.10 |
| Rate for Payer: Aetna Medicare |
$17,084.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,355.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,355.88
|
| Rate for Payer: BCBS MAPPO |
$17,084.70
|
| Rate for Payer: BCN Medicare Advantage |
$17,084.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,084.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,084.70
|
| Rate for Payer: Mclaren Medicare |
$17,084.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,938.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,647.40
|
| Rate for Payer: PACE Medicare |
$16,230.46
|
| Rate for Payer: PACE SWMI |
$17,084.70
|
| Rate for Payer: PHP Commercial |
$18,793.17
|
| Rate for Payer: PHP Medicare Advantage |
$17,084.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,361.10
|
| Rate for Payer: Priority Health Medicare |
$17,084.70
|
| Rate for Payer: Priority Health Narrow Network |
$18,688.88
|
| Rate for Payer: Railroad Medicare Medicare |
$17,084.70
|
| Rate for Payer: UHC Medicare Advantage |
$17,597.24
|
| Rate for Payer: VA VA |
$17,084.70
|
|
|
NEONATE WITH OTHER SIGNIFICANT PROBLEMS
|
Facility
|
IP
|
$19,130.32
|
|
|
Service Code
|
MS-DRG 794
|
| Min. Negotiated Rate |
$13,580.28 |
| Max. Negotiated Rate |
$19,130.32 |
| Rate for Payer: Aetna Medicare |
$14,295.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,868.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,868.79
|
| Rate for Payer: BCBS MAPPO |
$14,295.03
|
| Rate for Payer: BCN Medicare Advantage |
$14,295.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,295.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,295.03
|
| Rate for Payer: Mclaren Medicare |
$14,295.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,009.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,439.28
|
| Rate for Payer: PACE Medicare |
$13,580.28
|
| Rate for Payer: PACE SWMI |
$14,295.03
|
| Rate for Payer: PHP Commercial |
$15,724.53
|
| Rate for Payer: PHP Medicare Advantage |
$14,295.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,130.32
|
| Rate for Payer: Priority Health Medicare |
$14,295.03
|
| Rate for Payer: Priority Health Narrow Network |
$15,304.26
|
| Rate for Payer: Railroad Medicare Medicare |
$14,295.03
|
| Rate for Payer: UHC Medicare Advantage |
$14,723.88
|
| Rate for Payer: VA VA |
$14,295.03
|
|
|
NERVOUS SYSTEM NEOPLASMS WITH MCC
|
Facility
|
IP
|
$18,919.74
|
|
|
Service Code
|
MS-DRG 054
|
| Min. Negotiated Rate |
$13,448.37 |
| Max. Negotiated Rate |
$18,919.74 |
| Rate for Payer: Aetna Medicare |
$14,156.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,695.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,695.22
|
| Rate for Payer: BCBS MAPPO |
$14,156.18
|
| Rate for Payer: BCN Medicare Advantage |
$14,156.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,156.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,156.18
|
| Rate for Payer: Mclaren Medicare |
$14,156.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,863.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,279.61
|
| Rate for Payer: PACE Medicare |
$13,448.37
|
| Rate for Payer: PACE SWMI |
$14,156.18
|
| Rate for Payer: PHP Commercial |
$15,571.80
|
| Rate for Payer: PHP Medicare Advantage |
$14,156.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,919.74
|
| Rate for Payer: Priority Health Medicare |
$14,156.18
|
| Rate for Payer: Priority Health Narrow Network |
$15,135.79
|
| Rate for Payer: Railroad Medicare Medicare |
$14,156.18
|
| Rate for Payer: UHC Medicare Advantage |
$14,580.87
|
| Rate for Payer: VA VA |
$14,156.18
|
|
|
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC
|
Facility
|
IP
|
$13,779.89
|
|
|
Service Code
|
MS-DRG 055
|
| Min. Negotiated Rate |
$10,228.73 |
| Max. Negotiated Rate |
$13,779.89 |
| Rate for Payer: Aetna Medicare |
$10,767.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,458.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,458.85
|
| Rate for Payer: BCBS MAPPO |
$10,767.08
|
| Rate for Payer: BCN Medicare Advantage |
$10,767.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,767.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,767.08
|
| Rate for Payer: Mclaren Medicare |
$10,767.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,305.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,382.14
|
| Rate for Payer: PACE Medicare |
$10,228.73
|
| Rate for Payer: PACE SWMI |
$10,767.08
|
| Rate for Payer: PHP Commercial |
$11,843.79
|
| Rate for Payer: PHP Medicare Advantage |
$10,767.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,779.89
|
| Rate for Payer: Priority Health Medicare |
$10,767.08
|
| Rate for Payer: Priority Health Narrow Network |
$11,023.91
|
| Rate for Payer: Railroad Medicare Medicare |
$10,767.08
|
| Rate for Payer: UHC Medicare Advantage |
$11,090.09
|
| Rate for Payer: VA VA |
$10,767.08
|
|
|
NEUROLOGICAL EYE DISORDERS
|
Facility
|
IP
|
$10,609.91
|
|
|
Service Code
|
MS-DRG 123
|
| Min. Negotiated Rate |
$8,063.53 |
| Max. Negotiated Rate |
$10,609.91 |
| Rate for Payer: Aetna Medicare |
$8,487.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,609.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,609.91
|
| Rate for Payer: BCBS MAPPO |
$8,487.93
|
| Rate for Payer: BCN Medicare Advantage |
$8,487.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,487.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,487.93
|
| Rate for Payer: Mclaren Medicare |
$8,487.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,912.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,761.12
|
| Rate for Payer: PACE Medicare |
$8,063.53
|
| Rate for Payer: PACE SWMI |
$8,487.93
|
| Rate for Payer: PHP Commercial |
$9,336.72
|
| Rate for Payer: PHP Medicare Advantage |
$8,487.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,323.36
|
| Rate for Payer: Priority Health Medicare |
$8,487.93
|
| Rate for Payer: Priority Health Narrow Network |
$8,258.69
|
| Rate for Payer: Railroad Medicare Medicare |
$8,487.93
|
| Rate for Payer: UHC Medicare Advantage |
$8,742.57
|
| Rate for Payer: VA VA |
$8,487.93
|
|
|
NEUROSES EXCEPT DEPRESSIVE
|
Facility
|
IP
|
$12,060.61
|
|
|
Service Code
|
MS-DRG 882
|
| Min. Negotiated Rate |
$9,151.76 |
| Max. Negotiated Rate |
$12,060.61 |
| Rate for Payer: Aetna Medicare |
$9,633.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,041.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,041.79
|
| Rate for Payer: BCBS MAPPO |
$9,633.43
|
| Rate for Payer: BCN Medicare Advantage |
$9,633.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,633.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,633.43
|
| Rate for Payer: Mclaren Medicare |
$9,633.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,115.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,078.44
|
| Rate for Payer: PACE Medicare |
$9,151.76
|
| Rate for Payer: PACE SWMI |
$9,633.43
|
| Rate for Payer: PHP Commercial |
$10,596.77
|
| Rate for Payer: PHP Medicare Advantage |
$9,633.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,060.61
|
| Rate for Payer: Priority Health Medicare |
$9,633.43
|
| Rate for Payer: Priority Health Narrow Network |
$9,648.49
|
| Rate for Payer: Railroad Medicare Medicare |
$9,633.43
|
| Rate for Payer: UHC Medicare Advantage |
$9,922.43
|
| Rate for Payer: VA VA |
$9,633.43
|
|
