|
LISINOPRIL 5 MG TABLET
|
Facility
|
OP
|
$39.95
|
|
|
Service Code
|
NDC 68180051301
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Aetna Commercial |
$35.95
|
| Rate for Payer: Aetna Medicare |
$14.78
|
| Rate for Payer: ASR ASR |
$38.75
|
| Rate for Payer: BCBS Complete |
$15.98
|
| Rate for Payer: BCBS Trust/PPO |
$32.94
|
| Rate for Payer: BCN Commercial |
$32.94
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$37.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$38.75
|
| Rate for Payer: Healthscope Whirlpool |
$39.95
|
| Rate for Payer: Mclaren Commercial |
$35.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: Nomi Health Commercial |
$32.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$35.00
|
| Rate for Payer: Priority Health Narrow Network |
$28.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.16
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
IP
|
$39.95
|
|
|
Service Code
|
NDC 68180051301
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.96 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Aetna Commercial |
$35.95
|
| Rate for Payer: ASR ASR |
$38.75
|
| Rate for Payer: BCBS Trust/PPO |
$32.81
|
| Rate for Payer: BCN Commercial |
$32.81
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$37.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$38.75
|
| Rate for Payer: Healthscope Whirlpool |
$39.95
|
| Rate for Payer: Mclaren Commercial |
$35.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: Nomi Health Commercial |
$32.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.16
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
IP
|
$176.25
|
|
|
Service Code
|
NDC 904679761
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.19 |
| Max. Negotiated Rate |
$176.25 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: ASR ASR |
$170.96
|
| Rate for Payer: BCBS Trust/PPO |
$144.74
|
| Rate for Payer: BCN Commercial |
$144.74
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Commercial |
$165.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$170.96
|
| Rate for Payer: Healthscope Whirlpool |
$176.25
|
| Rate for Payer: Mclaren Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.81
|
| Rate for Payer: Nomi Health Commercial |
$144.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.10
|
|
|
LISINOPRIL 5 MG TABLET
|
Facility
|
OP
|
$176.25
|
|
|
Service Code
|
NDC 904679761
|
| Hospital Charge Code |
10451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.21 |
| Max. Negotiated Rate |
$176.25 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Aetna Medicare |
$65.21
|
| Rate for Payer: ASR ASR |
$170.96
|
| Rate for Payer: BCBS Complete |
$70.50
|
| Rate for Payer: BCBS Trust/PPO |
$145.32
|
| Rate for Payer: BCN Commercial |
$145.32
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Commercial |
$165.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$170.96
|
| Rate for Payer: Healthscope Whirlpool |
$176.25
|
| Rate for Payer: Mclaren Commercial |
$158.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.81
|
| Rate for Payer: Nomi Health Commercial |
$144.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$154.43
|
| Rate for Payer: Priority Health Narrow Network |
$123.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.10
|
|
|
LITHIUM CARBONATE 300 MG CAPSULE
|
Facility
|
IP
|
$1.92
|
|
|
Service Code
|
NDC 60687080611
|
| Hospital Charge Code |
4529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Aetna Commercial |
$1.73
|
| Rate for Payer: ASR ASR |
$1.86
|
| Rate for Payer: BCBS Trust/PPO |
$1.58
|
| Rate for Payer: BCN Commercial |
$1.58
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$1.86
|
| Rate for Payer: Healthscope Whirlpool |
$1.92
|
| Rate for Payer: Mclaren Commercial |
$1.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.63
|
| Rate for Payer: Nomi Health Commercial |
$1.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.69
|
|
|
LITHIUM CARBONATE 300 MG CAPSULE
|
Facility
|
IP
|
$21.09
|
|
|
Service Code
|
NDC 54852725
|
| Hospital Charge Code |
4529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.82 |
| Max. Negotiated Rate |
$21.09 |
| Rate for Payer: Aetna Commercial |
$18.98
|
| Rate for Payer: ASR ASR |
$20.46
|
| Rate for Payer: BCBS Trust/PPO |
$17.32
|
| Rate for Payer: BCN Commercial |
$17.32
|
| Rate for Payer: Cash Price |
$16.87
|
| Rate for Payer: Cofinity Commercial |
$19.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$20.46
|
| Rate for Payer: Healthscope Whirlpool |
$21.09
|
| Rate for Payer: Mclaren Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.93
|
| Rate for Payer: Nomi Health Commercial |
$17.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.56
|
|
|
LITHIUM CARBONATE 300 MG CAPSULE
|
Facility
|
OP
|
$191.90
|
|
|
Service Code
|
NDC 60687080601
|
| Hospital Charge Code |
4529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.00 |
| Max. Negotiated Rate |
$191.90 |
| Rate for Payer: Aetna Commercial |
$172.71
|
| Rate for Payer: Aetna Medicare |
$71.00
|
| Rate for Payer: ASR ASR |
$186.14
|
| Rate for Payer: BCBS Complete |
$76.76
|
| Rate for Payer: BCBS Trust/PPO |
$158.22
|
| Rate for Payer: BCN Commercial |
$158.22
|
| Rate for Payer: Cash Price |
$153.52
|
| Rate for Payer: Cofinity Commercial |
$180.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.52
|
| Rate for Payer: Healthscope Commercial |
$186.14
|
| Rate for Payer: Healthscope Whirlpool |
$191.90
|
| Rate for Payer: Mclaren Commercial |
$172.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.12
|
| Rate for Payer: Nomi Health Commercial |
$157.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$168.14
|
| Rate for Payer: Priority Health Narrow Network |
$134.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$168.87
|
|
|
LITHIUM CARBONATE 300 MG CAPSULE
|
Facility
|
OP
|
$1.92
|
|
|
Service Code
|
NDC 60687080611
|
| Hospital Charge Code |
4529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Aetna Commercial |
$1.73
|
| Rate for Payer: Aetna Medicare |
$0.71
|
| Rate for Payer: ASR ASR |
$1.86
|
| Rate for Payer: BCBS Complete |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$1.58
|
| Rate for Payer: BCN Commercial |
$1.58
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$1.86
|
| Rate for Payer: Healthscope Whirlpool |
$1.92
|
| Rate for Payer: Mclaren Commercial |
$1.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.63
|
| Rate for Payer: Nomi Health Commercial |
$1.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.68
|
| Rate for Payer: Priority Health Narrow Network |
$1.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.69
|
|
|
LITHIUM CARBONATE 300 MG CAPSULE
|
Facility
|
OP
|
$21.09
|
|
|
Service Code
|
NDC 54852725
|
| Hospital Charge Code |
4529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$21.09 |
| Rate for Payer: Aetna Commercial |
$18.98
|
| Rate for Payer: Aetna Medicare |
$7.80
|
| Rate for Payer: ASR ASR |
$20.46
|
| Rate for Payer: BCBS Complete |
$8.44
|
| Rate for Payer: BCBS Trust/PPO |
$17.39
|
| Rate for Payer: BCN Commercial |
$17.39
|
| Rate for Payer: Cash Price |
$16.87
|
| Rate for Payer: Cofinity Commercial |
$19.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$20.46
|
| Rate for Payer: Healthscope Whirlpool |
$21.09
|
| Rate for Payer: Mclaren Commercial |
$18.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.93
|
| Rate for Payer: Nomi Health Commercial |
$17.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.48
|
| Rate for Payer: Priority Health Narrow Network |
$14.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.56
|
|
|
LITHIUM CARBONATE 300 MG CAPSULE
|
Facility
|
IP
|
$191.90
|
|
|
Service Code
|
NDC 60687080601
|
| Hospital Charge Code |
4529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.93 |
| Max. Negotiated Rate |
$191.90 |
| Rate for Payer: Aetna Commercial |
$172.71
|
| Rate for Payer: ASR ASR |
$186.14
|
| Rate for Payer: BCBS Trust/PPO |
$157.59
|
| Rate for Payer: BCN Commercial |
$157.59
|
| Rate for Payer: Cash Price |
$153.52
|
| Rate for Payer: Cofinity Commercial |
$180.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.52
|
| Rate for Payer: Healthscope Commercial |
$186.14
|
| Rate for Payer: Healthscope Whirlpool |
$191.90
|
| Rate for Payer: Mclaren Commercial |
$172.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.12
|
| Rate for Payer: Nomi Health Commercial |
$157.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$168.87
|
|
|
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT
|
Facility
|
IP
|
$141,653.90
|
|
|
Service Code
|
MSDRG 005
|
| Min. Negotiated Rate |
$72,202.74 |
| Max. Negotiated Rate |
$141,653.90 |
| Rate for Payer: Aetna Medicare |
$76,002.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95,003.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95,003.60
|
| Rate for Payer: BCBS MAPPO |
$76,002.88
|
| Rate for Payer: BCN Medicare Advantage |
$76,002.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76,002.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$76,002.88
|
| Rate for Payer: Mclaren Medicare |
$76,002.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79,803.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87,403.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$83,603.17
|
| Rate for Payer: PACE Medicare |
$72,202.74
|
| Rate for Payer: PACE SWMI |
$76,002.88
|
| Rate for Payer: PHP Commercial |
$83,603.17
|
| Rate for Payer: PHP Medicare Advantage |
$76,002.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$141,653.90
|
| Rate for Payer: Priority Health Medicare |
$76,002.88
|
| Rate for Payer: Priority Health Narrow Network |
$113,323.12
|
| Rate for Payer: Railroad Medicare Medicare |
$76,002.88
|
| Rate for Payer: UHCCP DNSP |
$76,002.88
|
| Rate for Payer: VA VA |
$76,002.88
|
|
|
LIVER TRANSPLANT WITHOUT MCC
|
Facility
|
IP
|
$63,706.82
|
|
|
Service Code
|
MSDRG 006
|
| Min. Negotiated Rate |
$33,389.29 |
| Max. Negotiated Rate |
$63,706.82 |
| Rate for Payer: Aetna Medicare |
$35,146.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43,933.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43,933.28
|
| Rate for Payer: BCBS MAPPO |
$35,146.62
|
| Rate for Payer: BCN Medicare Advantage |
$35,146.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,146.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$35,146.62
|
| Rate for Payer: Mclaren Medicare |
$35,146.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36,903.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40,418.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$38,661.28
|
| Rate for Payer: PACE Medicare |
$33,389.29
|
| Rate for Payer: PACE SWMI |
$35,146.62
|
| Rate for Payer: PHP Commercial |
$38,661.28
|
| Rate for Payer: PHP Medicare Advantage |
$35,146.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$63,706.82
|
| Rate for Payer: Priority Health Medicare |
$35,146.62
|
| Rate for Payer: Priority Health Narrow Network |
$50,965.45
|
| Rate for Payer: Railroad Medicare Medicare |
$35,146.62
|
| Rate for Payer: UHCCP DNSP |
$35,146.62
|
| Rate for Payer: VA VA |
$35,146.62
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC
|
Facility
|
IP
|
$24,783.42
|
|
|
Service Code
|
MSDRG 496
|
| Min. Negotiated Rate |
$14,007.54 |
| Max. Negotiated Rate |
$24,783.42 |
| Rate for Payer: Aetna Medicare |
$14,744.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,430.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,430.97
|
| Rate for Payer: BCBS MAPPO |
$14,744.78
|
| Rate for Payer: BCN Medicare Advantage |
$14,744.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,744.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,744.78
|
| Rate for Payer: Mclaren Medicare |
$14,744.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,482.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,956.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,219.26
|
| Rate for Payer: PACE Medicare |
$14,007.54
|
| Rate for Payer: PACE SWMI |
$14,744.78
|
| Rate for Payer: PHP Commercial |
$16,219.26
|
| Rate for Payer: PHP Medicare Advantage |
$14,744.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$24,783.42
|
| Rate for Payer: Priority Health Medicare |
$14,744.78
|
| Rate for Payer: Priority Health Narrow Network |
$19,826.74
|
| Rate for Payer: Railroad Medicare Medicare |
$14,744.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,744.78
|
| Rate for Payer: UHC Exchange |
$22,854.41
|
| Rate for Payer: UHCCP DNSP |
$14,744.78
|
| Rate for Payer: VA VA |
$14,744.78
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC
|
Facility
|
IP
|
$49,812.77
|
|
|
Service Code
|
MSDRG 495
|
| Min. Negotiated Rate |
$26,470.81 |
| Max. Negotiated Rate |
$49,812.77 |
| Rate for Payer: Aetna Medicare |
$27,864.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,830.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,830.01
|
| Rate for Payer: BCBS MAPPO |
$27,864.01
|
| Rate for Payer: BCN Medicare Advantage |
$27,864.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,864.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$27,864.01
|
| Rate for Payer: Mclaren Medicare |
$27,864.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,257.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,043.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$30,650.41
|
| Rate for Payer: PACE Medicare |
$26,470.81
|
| Rate for Payer: PACE SWMI |
$27,864.01
|
| Rate for Payer: PHP Commercial |
$30,650.41
|
| Rate for Payer: PHP Medicare Advantage |
$27,864.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49,812.77
|
| Rate for Payer: Priority Health Medicare |
$27,864.01
|
| Rate for Payer: Priority Health Narrow Network |
$39,850.21
|
| Rate for Payer: Railroad Medicare Medicare |
$27,864.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27,864.01
|
| Rate for Payer: UHC Exchange |
$43,189.22
|
| Rate for Payer: UHCCP DNSP |
$27,864.01
|
| Rate for Payer: VA VA |
$27,864.01
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC
|
Facility
|
IP
|
$16,600.59
|
|
|
Service Code
|
MSDRG 497
|
| Min. Negotiated Rate |
$9,932.93 |
| Max. Negotiated Rate |
$16,600.59 |
| Rate for Payer: Aetna Medicare |
$10,455.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,069.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,069.65
|
| Rate for Payer: BCBS MAPPO |
$10,455.72
|
| Rate for Payer: BCN Medicare Advantage |
$10,455.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,455.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,455.72
|
| Rate for Payer: Mclaren Medicare |
$10,455.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,978.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,024.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,501.29
|
| Rate for Payer: PACE Medicare |
$9,932.93
|
| Rate for Payer: PACE SWMI |
$10,455.72
|
| Rate for Payer: PHP Commercial |
$11,501.29
|
| Rate for Payer: PHP Medicare Advantage |
$10,455.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16,600.59
|
| Rate for Payer: Priority Health Medicare |
$10,455.72
|
| Rate for Payer: Priority Health Narrow Network |
$13,280.47
|
| Rate for Payer: Railroad Medicare Medicare |
$10,455.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,455.72
|
| Rate for Payer: UHC Exchange |
$16,206.37
|
| Rate for Payer: UHCCP DNSP |
$10,455.72
|
| Rate for Payer: VA VA |
$10,455.72
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC
|
Facility
|
IP
|
$41,447.21
|
|
|
Service Code
|
MSDRG 498
|
| Min. Negotiated Rate |
$22,305.22 |
| Max. Negotiated Rate |
$41,447.21 |
| Rate for Payer: Aetna Medicare |
$23,479.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,348.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,348.97
|
| Rate for Payer: BCBS MAPPO |
$23,479.18
|
| Rate for Payer: BCN Medicare Advantage |
$23,479.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,479.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$23,479.18
|
| Rate for Payer: Mclaren Medicare |
$23,479.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24,653.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,001.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$25,827.10
|
| Rate for Payer: PACE Medicare |
$22,305.22
|
| Rate for Payer: PACE SWMI |
$23,479.18
|
| Rate for Payer: PHP Commercial |
$25,827.10
|
| Rate for Payer: PHP Medicare Advantage |
$23,479.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41,447.21
|
| Rate for Payer: Priority Health Medicare |
$23,479.18
|
| Rate for Payer: Priority Health Narrow Network |
$33,157.77
|
| Rate for Payer: Railroad Medicare Medicare |
$23,479.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23,479.18
|
| Rate for Payer: UHC Exchange |
$36,392.73
|
| Rate for Payer: UHCCP DNSP |
$23,479.18
|
| Rate for Payer: VA VA |
$23,479.18
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC
|
Facility
|
IP
|
$27,680.93
|
|
|
Service Code
|
MSDRG 499
|
| Min. Negotiated Rate |
$15,450.35 |
| Max. Negotiated Rate |
$27,680.93 |
| Rate for Payer: Aetna Medicare |
$16,263.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,329.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,329.41
|
| Rate for Payer: BCBS MAPPO |
$16,263.53
|
| Rate for Payer: BCN Medicare Advantage |
$16,263.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,263.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,263.53
|
| Rate for Payer: Mclaren Medicare |
$16,263.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,076.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,703.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,889.88
|
| Rate for Payer: PACE Medicare |
$15,450.35
|
| Rate for Payer: PACE SWMI |
$16,263.53
|
| Rate for Payer: PHP Commercial |
$17,889.88
|
| Rate for Payer: PHP Medicare Advantage |
$16,263.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27,680.93
|
| Rate for Payer: Priority Health Medicare |
$16,263.53
|
| Rate for Payer: Priority Health Narrow Network |
$22,144.75
|
| Rate for Payer: Railroad Medicare Medicare |
$16,263.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,263.53
|
| Rate for Payer: UHC Exchange |
$25,208.47
|
| Rate for Payer: UHCCP DNSP |
$16,263.53
|
| Rate for Payer: VA VA |
$16,263.53
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$3.21
|
|
|
Service Code
|
NDC 60687022911
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: ASR ASR |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$2.64
|
| Rate for Payer: BCN Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.57
|
| Rate for Payer: Healthscope Commercial |
$3.12
|
| Rate for Payer: Healthscope Whirlpool |
$3.21
|
| Rate for Payer: Mclaren Commercial |
$2.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.73
|
| Rate for Payer: Nomi Health Commercial |
$2.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.83
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$321.12
|
|
|
Service Code
|
NDC 60687022901
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.84 |
| Max. Negotiated Rate |
$321.12 |
| Rate for Payer: Aetna Commercial |
$289.01
|
| Rate for Payer: ASR ASR |
$311.49
|
| Rate for Payer: BCBS Trust/PPO |
$263.70
|
| Rate for Payer: BCN Commercial |
$263.70
|
| Rate for Payer: Cash Price |
$256.90
|
| Rate for Payer: Cofinity Commercial |
$301.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.90
|
| Rate for Payer: Healthscope Commercial |
$311.49
|
| Rate for Payer: Healthscope Whirlpool |
$321.12
|
| Rate for Payer: Mclaren Commercial |
$289.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.95
|
| Rate for Payer: Nomi Health Commercial |
$263.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$282.59
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$98.14
|
|
|
Service Code
|
NDC 70000046101
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$98.14 |
| Rate for Payer: Aetna Commercial |
$88.32
|
| Rate for Payer: ASR ASR |
$95.19
|
| Rate for Payer: BCBS Trust/PPO |
$80.59
|
| Rate for Payer: BCN Commercial |
$80.59
|
| Rate for Payer: Cash Price |
$78.51
|
| Rate for Payer: Cofinity Commercial |
$92.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.51
|
| Rate for Payer: Healthscope Commercial |
$95.19
|
| Rate for Payer: Healthscope Whirlpool |
$98.14
|
| Rate for Payer: Mclaren Commercial |
$88.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.42
|
| Rate for Payer: Nomi Health Commercial |
$80.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.36
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$3.21
|
|
|
Service Code
|
NDC 60687022911
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna Medicare |
$1.19
|
| Rate for Payer: ASR ASR |
$3.12
|
| Rate for Payer: BCBS Complete |
$1.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.65
|
| Rate for Payer: BCN Commercial |
$2.65
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.57
|
| Rate for Payer: Healthscope Commercial |
$3.12
|
| Rate for Payer: Healthscope Whirlpool |
$3.21
|
| Rate for Payer: Mclaren Commercial |
$2.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.73
|
| Rate for Payer: Nomi Health Commercial |
$2.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.81
|
| Rate for Payer: Priority Health Narrow Network |
$2.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.83
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$98.14
|
|
|
Service Code
|
NDC 70000046101
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.31 |
| Max. Negotiated Rate |
$98.14 |
| Rate for Payer: Aetna Commercial |
$88.32
|
| Rate for Payer: Aetna Medicare |
$36.31
|
| Rate for Payer: ASR ASR |
$95.19
|
| Rate for Payer: BCBS Complete |
$39.25
|
| Rate for Payer: BCBS Trust/PPO |
$80.91
|
| Rate for Payer: BCN Commercial |
$80.91
|
| Rate for Payer: Cash Price |
$78.51
|
| Rate for Payer: Cofinity Commercial |
$92.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.51
|
| Rate for Payer: Healthscope Commercial |
$95.19
|
| Rate for Payer: Healthscope Whirlpool |
$98.14
|
| Rate for Payer: Mclaren Commercial |
$88.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.42
|
| Rate for Payer: Nomi Health Commercial |
$80.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$85.99
|
| Rate for Payer: Priority Health Narrow Network |
$68.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.36
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$321.12
|
|
|
Service Code
|
NDC 60687022901
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.81 |
| Max. Negotiated Rate |
$321.12 |
| Rate for Payer: Aetna Commercial |
$289.01
|
| Rate for Payer: Aetna Medicare |
$118.81
|
| Rate for Payer: ASR ASR |
$311.49
|
| Rate for Payer: BCBS Complete |
$128.45
|
| Rate for Payer: BCBS Trust/PPO |
$264.76
|
| Rate for Payer: BCN Commercial |
$264.76
|
| Rate for Payer: Cash Price |
$256.90
|
| Rate for Payer: Cofinity Commercial |
$301.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.90
|
| Rate for Payer: Healthscope Commercial |
$311.49
|
| Rate for Payer: Healthscope Whirlpool |
$321.12
|
| Rate for Payer: Mclaren Commercial |
$289.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.95
|
| Rate for Payer: Nomi Health Commercial |
$263.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$281.37
|
| Rate for Payer: Priority Health Narrow Network |
$225.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$282.59
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
IP
|
$3.10
|
|
|
Service Code
|
NDC 51079069001
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Aetna Commercial |
$2.79
|
| Rate for Payer: ASR ASR |
$3.01
|
| Rate for Payer: BCBS Trust/PPO |
$2.55
|
| Rate for Payer: BCN Commercial |
$2.55
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.48
|
| Rate for Payer: Healthscope Commercial |
$3.01
|
| Rate for Payer: Healthscope Whirlpool |
$3.10
|
| Rate for Payer: Mclaren Commercial |
$2.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.64
|
| Rate for Payer: Nomi Health Commercial |
$2.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.73
|
|
|
LOPERAMIDE 2 MG CAPSULE
|
Facility
|
OP
|
$3.10
|
|
|
Service Code
|
NDC 51079069001
|
| Hospital Charge Code |
4560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Aetna Commercial |
$2.79
|
| Rate for Payer: Aetna Medicare |
$1.15
|
| Rate for Payer: ASR ASR |
$3.01
|
| Rate for Payer: BCBS Complete |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$2.56
|
| Rate for Payer: BCN Commercial |
$2.56
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.48
|
| Rate for Payer: Healthscope Commercial |
$3.01
|
| Rate for Payer: Healthscope Whirlpool |
$3.10
|
| Rate for Payer: Mclaren Commercial |
$2.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.64
|
| Rate for Payer: Nomi Health Commercial |
$2.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.72
|
| Rate for Payer: Priority Health Narrow Network |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.73
|
|
