|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 60687067501
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Aetna Commercial |
$194.09
|
| Rate for Payer: Aetna Medicare |
$79.79
|
| Rate for Payer: ASR ASR |
$209.18
|
| Rate for Payer: BCBS Complete |
$86.26
|
| Rate for Payer: BCBS Trust/PPO |
$177.80
|
| Rate for Payer: BCN Commercial |
$177.80
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$202.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$209.18
|
| Rate for Payer: Healthscope Whirlpool |
$215.65
|
| Rate for Payer: Mclaren Commercial |
$194.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$176.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$188.95
|
| Rate for Payer: Priority Health Narrow Network |
$151.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.77
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
NDC 60687067511
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: ASR ASR |
$2.09
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$1.78
|
| Rate for Payer: BCN Commercial |
$1.78
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$2.09
|
| Rate for Payer: Healthscope Whirlpool |
$2.16
|
| Rate for Payer: Mclaren Commercial |
$1.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.83
|
| Rate for Payer: Nomi Health Commercial |
$1.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.89
|
| Rate for Payer: Priority Health Narrow Network |
$1.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.90
|
|
|
HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE
|
Facility
|
OP
|
$753.63
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
17381
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$753.63 |
| Rate for Payer: Aetna Commercial |
$678.27
|
| Rate for Payer: Aetna Medicare |
$6.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.70
|
| Rate for Payer: ASR ASR |
$731.02
|
| Rate for Payer: BCBS Complete |
$3.82
|
| Rate for Payer: BCBS MAPPO |
$6.96
|
| Rate for Payer: BCBS Trust/PPO |
$621.37
|
| Rate for Payer: BCN Commercial |
$621.37
|
| Rate for Payer: BCN Medicare Advantage |
$6.96
|
| Rate for Payer: Cash Price |
$602.90
|
| Rate for Payer: Cash Price |
$602.90
|
| Rate for Payer: Cofinity Commercial |
$708.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$602.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.96
|
| Rate for Payer: Healthscope Commercial |
$731.02
|
| Rate for Payer: Healthscope Whirlpool |
$753.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.96
|
| Rate for Payer: Mclaren Commercial |
$678.27
|
| Rate for Payer: Mclaren Medicaid |
$6.96
|
| Rate for Payer: Mclaren Medicare |
$6.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.31
|
| Rate for Payer: Meridian Medicaid |
$3.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$640.59
|
| Rate for Payer: Nomi Health Commercial |
$617.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$565.22
|
| Rate for Payer: PACE Medicare |
$6.61
|
| Rate for Payer: PACE SWMI |
$6.96
|
| Rate for Payer: PHP Commercial |
$7.66
|
| Rate for Payer: PHP Medicaid |
$3.73
|
| Rate for Payer: PHP Medicare Advantage |
$6.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.85
|
| Rate for Payer: Priority Health Medicare |
$6.96
|
| Rate for Payer: Priority Health Narrow Network |
$6.28
|
| Rate for Payer: Railroad Medicare Medicare |
$6.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$663.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.96
|
| Rate for Payer: UHC Exchange |
$10.79
|
| Rate for Payer: UHC Medicaid |
$3.64
|
| Rate for Payer: UHCCP DNSP |
$6.96
|
| Rate for Payer: UHCCP Medicaid |
$3.64
|
| Rate for Payer: VA VA |
$6.96
|
|
|
HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE
|
Facility
|
IP
|
$753.63
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
17381
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$565.22 |
| Max. Negotiated Rate |
$753.63 |
| Rate for Payer: Aetna Commercial |
$678.27
|
| Rate for Payer: ASR ASR |
$731.02
|
| Rate for Payer: BCBS Trust/PPO |
$618.88
|
| Rate for Payer: BCN Commercial |
$618.88
|
| Rate for Payer: Cash Price |
$602.90
|
| Rate for Payer: Cofinity Commercial |
$708.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$602.90
|
| Rate for Payer: Healthscope Commercial |
$731.02
|
| Rate for Payer: Healthscope Whirlpool |
$753.63
|
| Rate for Payer: Mclaren Commercial |
$678.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$640.59
|
| Rate for Payer: Nomi Health Commercial |
$617.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$565.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$663.19
|
|
|
HYLAN G-F 20 48 MG/6 ML INTRA-ARTICULAR SYRINGE
|
Facility
|
OP
|
$2,037.98
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
118765
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$2,037.98 |
| Rate for Payer: Aetna Commercial |
$1,834.19
|
| Rate for Payer: Aetna Medicare |
$6.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.70
|
| Rate for Payer: ASR ASR |
$1,976.84
|
| Rate for Payer: BCBS Complete |
$3.82
|
| Rate for Payer: BCBS MAPPO |
$6.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,680.32
|
| Rate for Payer: BCN Commercial |
$1,680.32
|
| Rate for Payer: BCN Medicare Advantage |
$6.96
|
| Rate for Payer: Cash Price |
$1,630.39
|
| Rate for Payer: Cash Price |
$1,630.39
|
| Rate for Payer: Cofinity Commercial |
$1,915.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,630.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.96
|
| Rate for Payer: Healthscope Commercial |
$1,976.84
|
| Rate for Payer: Healthscope Whirlpool |
$2,037.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.96
|
| Rate for Payer: Mclaren Commercial |
$1,834.19
|
| Rate for Payer: Mclaren Medicaid |
$6.96
|
| Rate for Payer: Mclaren Medicare |
$6.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.31
|
| Rate for Payer: Meridian Medicaid |
$3.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,732.29
|
| Rate for Payer: Nomi Health Commercial |
$1,671.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,528.49
|
| Rate for Payer: PACE Medicare |
$6.61
|
| Rate for Payer: PACE SWMI |
$6.96
|
| Rate for Payer: PHP Commercial |
$7.66
|
| Rate for Payer: PHP Medicaid |
$3.73
|
| Rate for Payer: PHP Medicare Advantage |
$6.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.85
|
| Rate for Payer: Priority Health Medicare |
$6.96
|
| Rate for Payer: Priority Health Narrow Network |
$6.28
|
| Rate for Payer: Railroad Medicare Medicare |
$6.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,793.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.96
|
| Rate for Payer: UHC Exchange |
$10.79
|
| Rate for Payer: UHC Medicaid |
$3.64
|
| Rate for Payer: UHCCP DNSP |
$6.96
|
| Rate for Payer: UHCCP Medicaid |
$3.64
|
| Rate for Payer: VA VA |
$6.96
|
|
|
HYLAN G-F 20 48 MG/6 ML INTRA-ARTICULAR SYRINGE
|
Facility
|
IP
|
$2,037.98
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
118765
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,528.49 |
| Max. Negotiated Rate |
$2,037.98 |
| Rate for Payer: Aetna Commercial |
$1,834.19
|
| Rate for Payer: ASR ASR |
$1,976.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,673.59
|
| Rate for Payer: BCN Commercial |
$1,673.59
|
| Rate for Payer: Cash Price |
$1,630.39
|
| Rate for Payer: Cofinity Commercial |
$1,915.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,630.39
|
| Rate for Payer: Healthscope Commercial |
$1,976.84
|
| Rate for Payer: Healthscope Whirlpool |
$2,037.98
|
| Rate for Payer: Mclaren Commercial |
$1,834.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,732.29
|
| Rate for Payer: Nomi Health Commercial |
$1,671.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,528.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,793.43
|
|
|
HYOSCYAMINE SULFATE 0.125 MG TABLET
|
Facility
|
OP
|
$204.45
|
|
|
Service Code
|
NDC 47781001301
|
| Hospital Charge Code |
3783
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$204.45 |
| Rate for Payer: Aetna Commercial |
$184.00
|
| Rate for Payer: Aetna Medicare |
$75.65
|
| Rate for Payer: ASR ASR |
$198.32
|
| Rate for Payer: BCBS Complete |
$81.78
|
| Rate for Payer: BCBS Trust/PPO |
$168.57
|
| Rate for Payer: BCN Commercial |
$168.57
|
| Rate for Payer: Cash Price |
$163.56
|
| Rate for Payer: Cofinity Commercial |
$192.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.56
|
| Rate for Payer: Healthscope Commercial |
$198.32
|
| Rate for Payer: Healthscope Whirlpool |
$204.45
|
| Rate for Payer: Mclaren Commercial |
$184.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.78
|
| Rate for Payer: Nomi Health Commercial |
$167.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$179.14
|
| Rate for Payer: Priority Health Narrow Network |
$143.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.92
|
|
|
HYOSCYAMINE SULFATE 0.125 MG TABLET
|
Facility
|
IP
|
$204.45
|
|
|
Service Code
|
NDC 47781001301
|
| Hospital Charge Code |
3783
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.34 |
| Max. Negotiated Rate |
$204.45 |
| Rate for Payer: Aetna Commercial |
$184.00
|
| Rate for Payer: ASR ASR |
$198.32
|
| Rate for Payer: BCBS Trust/PPO |
$167.89
|
| Rate for Payer: BCN Commercial |
$167.89
|
| Rate for Payer: Cash Price |
$163.56
|
| Rate for Payer: Cofinity Commercial |
$192.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.56
|
| Rate for Payer: Healthscope Commercial |
$198.32
|
| Rate for Payer: Healthscope Whirlpool |
$204.45
|
| Rate for Payer: Mclaren Commercial |
$184.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.78
|
| Rate for Payer: Nomi Health Commercial |
$167.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.92
|
|
|
HYOSCYAMINE SULFATE 0.125 MG TABLET
|
Facility
|
OP
|
$399.50
|
|
|
Service Code
|
NDC 62559042101
|
| Hospital Charge Code |
3783
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.81 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Aetna Commercial |
$359.55
|
| Rate for Payer: Aetna Medicare |
$147.81
|
| Rate for Payer: ASR ASR |
$387.51
|
| Rate for Payer: BCBS Complete |
$159.80
|
| Rate for Payer: BCBS Trust/PPO |
$329.39
|
| Rate for Payer: BCN Commercial |
$329.39
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Commercial |
$375.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.60
|
| Rate for Payer: Healthscope Commercial |
$387.51
|
| Rate for Payer: Healthscope Whirlpool |
$399.50
|
| Rate for Payer: Mclaren Commercial |
$359.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$319.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.57
|
| Rate for Payer: Nomi Health Commercial |
$327.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$350.04
|
| Rate for Payer: Priority Health Narrow Network |
$280.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$351.56
|
|
|
HYOSCYAMINE SULFATE 0.125 MG TABLET
|
Facility
|
IP
|
$399.50
|
|
|
Service Code
|
NDC 62559042101
|
| Hospital Charge Code |
3783
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$299.62 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Aetna Commercial |
$359.55
|
| Rate for Payer: ASR ASR |
$387.51
|
| Rate for Payer: BCBS Trust/PPO |
$328.07
|
| Rate for Payer: BCN Commercial |
$328.07
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Commercial |
$375.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.60
|
| Rate for Payer: Healthscope Commercial |
$387.51
|
| Rate for Payer: Healthscope Whirlpool |
$399.50
|
| Rate for Payer: Mclaren Commercial |
$359.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.57
|
| Rate for Payer: Nomi Health Commercial |
$327.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$351.56
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$4,431.53
|
|
|
Service Code
|
APR-DRG 1992
|
| Min. Negotiated Rate |
$4,006.64 |
| Max. Negotiated Rate |
$4,431.53 |
| Rate for Payer: BCBS Complete |
$4,431.53
|
| Rate for Payer: Mclaren Medicaid |
$4,220.51
|
| Rate for Payer: Meridian Medicaid |
$4,431.53
|
| Rate for Payer: PHP Medicaid |
$4,006.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,220.51
|
| Rate for Payer: UHC Medicaid |
$4,220.51
|
| Rate for Payer: UHCCP Medicaid |
$4,220.51
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$10,514.81
|
|
|
Service Code
|
APR-DRG 1994
|
| Min. Negotiated Rate |
$9,506.65 |
| Max. Negotiated Rate |
$10,514.81 |
| Rate for Payer: BCBS Complete |
$10,514.81
|
| Rate for Payer: Mclaren Medicaid |
$10,014.10
|
| Rate for Payer: Meridian Medicaid |
$10,514.81
|
| Rate for Payer: PHP Medicaid |
$9,506.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,014.10
|
| Rate for Payer: UHC Medicaid |
$10,014.10
|
| Rate for Payer: UHCCP Medicaid |
$10,014.10
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$5,549.77
|
|
|
Service Code
|
APR-DRG 1993
|
| Min. Negotiated Rate |
$5,017.66 |
| Max. Negotiated Rate |
$5,549.77 |
| Rate for Payer: BCBS Complete |
$5,549.77
|
| Rate for Payer: Mclaren Medicaid |
$5,285.50
|
| Rate for Payer: Meridian Medicaid |
$5,549.77
|
| Rate for Payer: PHP Medicaid |
$5,017.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,285.50
|
| Rate for Payer: UHC Medicaid |
$5,285.50
|
| Rate for Payer: UHCCP Medicaid |
$5,285.50
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$4,095.84
|
|
|
Service Code
|
APR-DRG 1991
|
| Min. Negotiated Rate |
$3,703.13 |
| Max. Negotiated Rate |
$4,095.84 |
| Rate for Payer: BCBS Complete |
$4,095.84
|
| Rate for Payer: Mclaren Medicaid |
$3,900.80
|
| Rate for Payer: Meridian Medicaid |
$4,095.84
|
| Rate for Payer: PHP Medicaid |
$3,703.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,900.80
|
| Rate for Payer: UHC Medicaid |
$3,900.80
|
| Rate for Payer: UHCCP Medicaid |
$3,900.80
|
|
|
HYPERTENSION WITH MCC
|
Facility
|
IP
|
$16,349.17
|
|
|
Service Code
|
MSDRG 304
|
| Min. Negotiated Rate |
$9,807.74 |
| Max. Negotiated Rate |
$16,349.17 |
| Rate for Payer: Aetna Medicare |
$10,323.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,904.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,904.92
|
| Rate for Payer: BCBS MAPPO |
$10,323.94
|
| Rate for Payer: BCN Medicare Advantage |
$10,323.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,323.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,323.94
|
| Rate for Payer: Mclaren Medicare |
$10,323.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,840.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,872.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,356.33
|
| Rate for Payer: PACE Medicare |
$9,807.74
|
| Rate for Payer: PACE SWMI |
$10,323.94
|
| Rate for Payer: PHP Commercial |
$11,356.33
|
| Rate for Payer: PHP Medicare Advantage |
$10,323.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16,349.17
|
| Rate for Payer: Priority Health Medicare |
$10,323.94
|
| Rate for Payer: Priority Health Narrow Network |
$13,079.34
|
| Rate for Payer: Railroad Medicare Medicare |
$10,323.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,323.94
|
| Rate for Payer: UHC Exchange |
$16,002.11
|
| Rate for Payer: UHCCP DNSP |
$10,323.94
|
| Rate for Payer: VA VA |
$10,323.94
|
|
|
HYPERTENSION WITHOUT MCC
|
Facility
|
IP
|
$11,147.79
|
|
|
Service Code
|
MSDRG 305
|
| Min. Negotiated Rate |
$6,832.51 |
| Max. Negotiated Rate |
$11,147.79 |
| Rate for Payer: Aetna Medicare |
$7,192.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,990.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,990.15
|
| Rate for Payer: BCBS MAPPO |
$7,192.12
|
| Rate for Payer: BCN Medicare Advantage |
$7,192.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,192.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,192.12
|
| Rate for Payer: Mclaren Medicare |
$7,192.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,551.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,270.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,911.33
|
| Rate for Payer: PACE Medicare |
$6,832.51
|
| Rate for Payer: PACE SWMI |
$7,192.12
|
| Rate for Payer: PHP Commercial |
$7,911.33
|
| Rate for Payer: PHP Medicare Advantage |
$7,192.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,374.17
|
| Rate for Payer: Priority Health Medicare |
$7,192.12
|
| Rate for Payer: Priority Health Narrow Network |
$8,299.33
|
| Rate for Payer: Railroad Medicare Medicare |
$7,192.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,192.12
|
| Rate for Payer: UHC Exchange |
$11,147.79
|
| Rate for Payer: UHCCP DNSP |
$7,192.12
|
| Rate for Payer: VA VA |
$7,192.12
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$2,899.68
|
|
|
Service Code
|
APR-DRG 4222
|
| Min. Negotiated Rate |
$2,621.66 |
| Max. Negotiated Rate |
$2,899.68 |
| Rate for Payer: BCBS Complete |
$2,899.68
|
| Rate for Payer: Mclaren Medicaid |
$2,761.60
|
| Rate for Payer: Meridian Medicaid |
$2,899.68
|
| Rate for Payer: PHP Medicaid |
$2,621.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,761.60
|
| Rate for Payer: UHC Medicaid |
$2,761.60
|
| Rate for Payer: UHCCP Medicaid |
$2,761.60
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$4,051.70
|
|
|
Service Code
|
APR-DRG 4223
|
| Min. Negotiated Rate |
$3,663.22 |
| Max. Negotiated Rate |
$4,051.70 |
| Rate for Payer: BCBS Complete |
$4,051.70
|
| Rate for Payer: Mclaren Medicaid |
$3,858.76
|
| Rate for Payer: Meridian Medicaid |
$4,051.70
|
| Rate for Payer: PHP Medicaid |
$3,663.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,858.76
|
| Rate for Payer: UHC Medicaid |
$3,858.76
|
| Rate for Payer: UHCCP Medicaid |
$3,858.76
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$8,018.39
|
|
|
Service Code
|
APR-DRG 4224
|
| Min. Negotiated Rate |
$7,249.59 |
| Max. Negotiated Rate |
$8,018.39 |
| Rate for Payer: BCBS Complete |
$8,018.39
|
| Rate for Payer: Mclaren Medicaid |
$7,636.57
|
| Rate for Payer: Meridian Medicaid |
$8,018.39
|
| Rate for Payer: PHP Medicaid |
$7,249.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,636.57
|
| Rate for Payer: UHC Medicaid |
$7,636.57
|
| Rate for Payer: UHCCP Medicaid |
$7,636.57
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$2,159.09
|
|
|
Service Code
|
APR-DRG 4221
|
| Min. Negotiated Rate |
$1,952.08 |
| Max. Negotiated Rate |
$2,159.09 |
| Rate for Payer: BCBS Complete |
$2,159.09
|
| Rate for Payer: Mclaren Medicaid |
$2,056.28
|
| Rate for Payer: Meridian Medicaid |
$2,159.09
|
| Rate for Payer: PHP Medicaid |
$1,952.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,056.28
|
| Rate for Payer: UHC Medicaid |
$2,056.28
|
| Rate for Payer: UHCCP Medicaid |
$2,056.28
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.62
|
|
|
Service Code
|
NDC 121091400
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna Commercial |
$2.35
|
| Rate for Payer: ASR ASR |
$2.54
|
| Rate for Payer: BCBS Trust/PPO |
$2.15
|
| Rate for Payer: BCN Commercial |
$2.15
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.09
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: Healthscope Whirlpool |
$2.62
|
| Rate for Payer: Mclaren Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.22
|
| Rate for Payer: Nomi Health Commercial |
$2.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.30
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
NDC 68094060059
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$4.30 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Aetna Medicare |
$1.59
|
| Rate for Payer: ASR ASR |
$4.17
|
| Rate for Payer: BCBS Complete |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$3.54
|
| Rate for Payer: BCN Commercial |
$3.54
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$4.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$4.17
|
| Rate for Payer: Healthscope Whirlpool |
$4.30
|
| Rate for Payer: Mclaren Commercial |
$3.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Nomi Health Commercial |
$3.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.76
|
| Rate for Payer: Priority Health Narrow Network |
$3.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.78
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
NDC 68094060061
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$4.30 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Aetna Medicare |
$1.59
|
| Rate for Payer: ASR ASR |
$4.17
|
| Rate for Payer: BCBS Complete |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$3.54
|
| Rate for Payer: BCN Commercial |
$3.54
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$4.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$4.17
|
| Rate for Payer: Healthscope Whirlpool |
$4.30
|
| Rate for Payer: Mclaren Commercial |
$3.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Nomi Health Commercial |
$3.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.76
|
| Rate for Payer: Priority Health Narrow Network |
$3.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.78
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.64
|
|
|
Service Code
|
NDC 68094049459
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$2.64 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: ASR ASR |
$2.56
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.11
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Healthscope Whirlpool |
$2.64
|
| Rate for Payer: Mclaren Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.24
|
| Rate for Payer: Nomi Health Commercial |
$2.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.32
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.98
|
|
|
Service Code
|
NDC 60687074317
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Aetna Commercial |
$2.68
|
| Rate for Payer: ASR ASR |
$2.89
|
| Rate for Payer: BCBS Trust/PPO |
$2.44
|
| Rate for Payer: BCN Commercial |
$2.44
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.38
|
| Rate for Payer: Healthscope Commercial |
$2.89
|
| Rate for Payer: Healthscope Whirlpool |
$2.98
|
| Rate for Payer: Mclaren Commercial |
$2.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.53
|
| Rate for Payer: Nomi Health Commercial |
$2.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.62
|
|
