|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
|
IP
|
$11,692.49
|
|
|
Service Code
|
MSDRG 561
|
| Min. Negotiated Rate |
$7,166.36 |
| Max. Negotiated Rate |
$11,692.49 |
| Rate for Payer: Aetna Medicare |
$7,543.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,429.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,429.42
|
| Rate for Payer: BCBS MAPPO |
$7,543.54
|
| Rate for Payer: BCN Medicare Advantage |
$7,543.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,543.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,543.54
|
| Rate for Payer: Mclaren Medicare |
$7,543.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,920.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,675.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,297.89
|
| Rate for Payer: PACE Medicare |
$7,166.36
|
| Rate for Payer: PACE SWMI |
$7,543.54
|
| Rate for Payer: PHP Commercial |
$8,297.89
|
| Rate for Payer: PHP Medicare Advantage |
$7,543.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,044.62
|
| Rate for Payer: Priority Health Medicare |
$7,543.54
|
| Rate for Payer: Priority Health Narrow Network |
$8,835.70
|
| Rate for Payer: Railroad Medicare Medicare |
$7,543.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,543.54
|
| Rate for Payer: UHC Exchange |
$11,692.49
|
| Rate for Payer: UHCCP DNSP |
$7,543.54
|
| Rate for Payer: VA VA |
$7,543.54
|
|
|
AFTERCARE WITH CC/MCC
|
Facility
|
IP
|
$16,345.05
|
|
|
Service Code
|
MSDRG 949
|
| Min. Negotiated Rate |
$9,805.69 |
| Max. Negotiated Rate |
$16,345.05 |
| Rate for Payer: Aetna Medicare |
$10,321.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,902.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,902.23
|
| Rate for Payer: BCBS MAPPO |
$10,321.78
|
| Rate for Payer: BCN Medicare Advantage |
$10,321.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,321.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,321.78
|
| Rate for Payer: Mclaren Medicare |
$10,321.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,837.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,870.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,353.96
|
| Rate for Payer: PACE Medicare |
$9,805.69
|
| Rate for Payer: PACE SWMI |
$10,321.78
|
| Rate for Payer: PHP Commercial |
$11,353.96
|
| Rate for Payer: PHP Medicare Advantage |
$10,321.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16,345.05
|
| Rate for Payer: Priority Health Medicare |
$10,321.78
|
| Rate for Payer: Priority Health Narrow Network |
$13,076.04
|
| Rate for Payer: Railroad Medicare Medicare |
$10,321.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,321.78
|
| Rate for Payer: UHC Exchange |
$15,998.76
|
| Rate for Payer: UHCCP DNSP |
$10,321.78
|
| Rate for Payer: VA VA |
$10,321.78
|
|
|
AFTERCARE WITHOUT CC/MCC
|
Facility
|
IP
|
$9,725.75
|
|
|
Service Code
|
MSDRG 950
|
| Min. Negotiated Rate |
$5,960.95 |
| Max. Negotiated Rate |
$9,725.75 |
| Rate for Payer: Aetna Medicare |
$6,274.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,843.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,843.35
|
| Rate for Payer: BCBS MAPPO |
$6,274.68
|
| Rate for Payer: BCN Medicare Advantage |
$6,274.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,274.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,274.68
|
| Rate for Payer: Mclaren Medicare |
$6,274.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,588.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,215.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,902.15
|
| Rate for Payer: PACE Medicare |
$5,960.95
|
| Rate for Payer: PACE SWMI |
$6,274.68
|
| Rate for Payer: PHP Commercial |
$6,902.15
|
| Rate for Payer: PHP Medicare Advantage |
$6,274.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8,623.84
|
| Rate for Payer: Priority Health Medicare |
$6,274.68
|
| Rate for Payer: Priority Health Narrow Network |
$6,899.08
|
| Rate for Payer: Railroad Medicare Medicare |
$6,274.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,274.68
|
| Rate for Payer: UHC Exchange |
$9,725.75
|
| Rate for Payer: UHCCP DNSP |
$6,274.68
|
| Rate for Payer: VA VA |
$6,274.68
|
|
|
AICD GENERATOR PROCEDURES
|
Facility
|
IP
|
$62,681.90
|
|
|
Service Code
|
MSDRG 245
|
| Min. Negotiated Rate |
$32,878.95 |
| Max. Negotiated Rate |
$62,681.90 |
| Rate for Payer: Aetna Medicare |
$34,609.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43,261.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43,261.78
|
| Rate for Payer: BCBS MAPPO |
$34,609.42
|
| Rate for Payer: BCN Medicare Advantage |
$34,609.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34,609.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$34,609.42
|
| Rate for Payer: Mclaren Medicare |
$34,609.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36,339.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39,800.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$38,070.36
|
| Rate for Payer: PACE Medicare |
$32,878.95
|
| Rate for Payer: PACE SWMI |
$34,609.42
|
| Rate for Payer: PHP Commercial |
$38,070.36
|
| Rate for Payer: PHP Medicare Advantage |
$34,609.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$62,681.90
|
| Rate for Payer: Priority Health Medicare |
$34,609.42
|
| Rate for Payer: Priority Health Narrow Network |
$50,145.52
|
| Rate for Payer: Railroad Medicare Medicare |
$34,609.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$34,609.42
|
| Rate for Payer: UHC Exchange |
$53,644.60
|
| Rate for Payer: UHCCP DNSP |
$34,609.42
|
| Rate for Payer: VA VA |
$34,609.42
|
|
|
AICD LEAD PROCEDURES
|
Facility
|
IP
|
$49,709.73
|
|
|
Service Code
|
MSDRG 265
|
| Min. Negotiated Rate |
$26,419.49 |
| Max. Negotiated Rate |
$49,709.73 |
| Rate for Payer: Aetna Medicare |
$27,809.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,762.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,762.49
|
| Rate for Payer: BCBS MAPPO |
$27,809.99
|
| Rate for Payer: BCN Medicare Advantage |
$27,809.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,809.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$27,809.99
|
| Rate for Payer: Mclaren Medicare |
$27,809.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,200.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,981.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$30,590.99
|
| Rate for Payer: PACE Medicare |
$26,419.49
|
| Rate for Payer: PACE SWMI |
$27,809.99
|
| Rate for Payer: PHP Commercial |
$30,590.99
|
| Rate for Payer: PHP Medicare Advantage |
$27,809.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49,709.73
|
| Rate for Payer: Priority Health Medicare |
$27,809.99
|
| Rate for Payer: Priority Health Narrow Network |
$39,767.78
|
| Rate for Payer: Railroad Medicare Medicare |
$27,809.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27,809.99
|
| Rate for Payer: UHC Exchange |
$43,105.48
|
| Rate for Payer: UHCCP DNSP |
$27,809.99
|
| Rate for Payer: VA VA |
$27,809.99
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$278.68
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
8981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$209.01 |
| Max. Negotiated Rate |
$278.68 |
| Rate for Payer: Aetna Commercial |
$250.81
|
| Rate for Payer: Aetna Commercial |
$217.58
|
| Rate for Payer: Aetna Commercial |
$255.60
|
| Rate for Payer: Aetna Commercial |
$211.83
|
| Rate for Payer: ASR ASR |
$275.48
|
| Rate for Payer: ASR ASR |
$270.31
|
| Rate for Payer: ASR ASR |
$234.50
|
| Rate for Payer: ASR ASR |
$228.30
|
| Rate for Payer: BCBS Trust/PPO |
$228.85
|
| Rate for Payer: BCBS Trust/PPO |
$193.28
|
| Rate for Payer: BCBS Trust/PPO |
$198.53
|
| Rate for Payer: BCBS Trust/PPO |
$233.22
|
| Rate for Payer: BCN Commercial |
$193.28
|
| Rate for Payer: BCN Commercial |
$233.22
|
| Rate for Payer: BCN Commercial |
$198.53
|
| Rate for Payer: BCN Commercial |
$228.85
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$193.40
|
| Rate for Payer: Cash Price |
$222.94
|
| Rate for Payer: Cash Price |
$188.29
|
| Rate for Payer: Cofinity Commercial |
$261.95
|
| Rate for Payer: Cofinity Commercial |
$221.24
|
| Rate for Payer: Cofinity Commercial |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$227.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.29
|
| Rate for Payer: Healthscope Commercial |
$270.31
|
| Rate for Payer: Healthscope Commercial |
$228.30
|
| Rate for Payer: Healthscope Commercial |
$234.50
|
| Rate for Payer: Healthscope Commercial |
$275.48
|
| Rate for Payer: Healthscope Whirlpool |
$278.68
|
| Rate for Payer: Healthscope Whirlpool |
$284.00
|
| Rate for Payer: Healthscope Whirlpool |
$235.37
|
| Rate for Payer: Healthscope Whirlpool |
$241.75
|
| Rate for Payer: Mclaren Commercial |
$211.83
|
| Rate for Payer: Mclaren Commercial |
$255.60
|
| Rate for Payer: Mclaren Commercial |
$217.58
|
| Rate for Payer: Mclaren Commercial |
$250.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.06
|
| Rate for Payer: Nomi Health Commercial |
$198.24
|
| Rate for Payer: Nomi Health Commercial |
$232.88
|
| Rate for Payer: Nomi Health Commercial |
$228.51
|
| Rate for Payer: Nomi Health Commercial |
$193.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.92
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$241.76
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
8981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.76 |
| Max. Negotiated Rate |
$241.75 |
| Rate for Payer: Aetna Commercial |
$217.58
|
| Rate for Payer: Aetna Commercial |
$211.83
|
| Rate for Payer: Aetna Commercial |
$255.60
|
| Rate for Payer: Aetna Commercial |
$250.81
|
| Rate for Payer: Aetna Medicare |
$53.08
|
| Rate for Payer: Aetna Medicare |
$53.08
|
| Rate for Payer: Aetna Medicare |
$53.08
|
| Rate for Payer: Aetna Medicare |
$53.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.35
|
| Rate for Payer: ASR ASR |
$275.48
|
| Rate for Payer: ASR ASR |
$228.30
|
| Rate for Payer: ASR ASR |
$270.31
|
| Rate for Payer: ASR ASR |
$234.50
|
| Rate for Payer: BCBS Complete |
$29.15
|
| Rate for Payer: BCBS Complete |
$29.15
|
| Rate for Payer: BCBS Complete |
$29.15
|
| Rate for Payer: BCBS Complete |
$29.15
|
| Rate for Payer: BCBS MAPPO |
$53.08
|
| Rate for Payer: BCBS MAPPO |
$53.08
|
| Rate for Payer: BCBS MAPPO |
$53.08
|
| Rate for Payer: BCBS MAPPO |
$53.08
|
| Rate for Payer: BCBS Trust/PPO |
$194.06
|
| Rate for Payer: BCBS Trust/PPO |
$229.77
|
| Rate for Payer: BCBS Trust/PPO |
$199.33
|
| Rate for Payer: BCBS Trust/PPO |
$234.16
|
| Rate for Payer: BCN Commercial |
$194.06
|
| Rate for Payer: BCN Commercial |
$199.33
|
| Rate for Payer: BCN Commercial |
$234.16
|
| Rate for Payer: BCN Commercial |
$229.77
|
| Rate for Payer: BCN Medicare Advantage |
$53.08
|
| Rate for Payer: BCN Medicare Advantage |
$53.08
|
| Rate for Payer: BCN Medicare Advantage |
$53.08
|
| Rate for Payer: BCN Medicare Advantage |
$53.08
|
| Rate for Payer: Cash Price |
$193.40
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$188.29
|
| Rate for Payer: Cash Price |
$188.29
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$193.40
|
| Rate for Payer: Cash Price |
$222.94
|
| Rate for Payer: Cash Price |
$222.94
|
| Rate for Payer: Cofinity Commercial |
$221.24
|
| Rate for Payer: Cofinity Commercial |
$261.95
|
| Rate for Payer: Cofinity Commercial |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$227.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.08
|
| Rate for Payer: Healthscope Commercial |
$228.30
|
| Rate for Payer: Healthscope Commercial |
$275.48
|
| Rate for Payer: Healthscope Commercial |
$234.50
|
| Rate for Payer: Healthscope Commercial |
$270.31
|
| Rate for Payer: Healthscope Whirlpool |
$284.00
|
| Rate for Payer: Healthscope Whirlpool |
$235.37
|
| Rate for Payer: Healthscope Whirlpool |
$278.68
|
| Rate for Payer: Healthscope Whirlpool |
$241.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$53.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$53.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$53.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$53.08
|
| Rate for Payer: Mclaren Commercial |
$255.60
|
| Rate for Payer: Mclaren Commercial |
$217.58
|
| Rate for Payer: Mclaren Commercial |
$211.83
|
| Rate for Payer: Mclaren Commercial |
$250.81
|
| Rate for Payer: Mclaren Medicaid |
$53.08
|
| Rate for Payer: Mclaren Medicaid |
$53.08
|
| Rate for Payer: Mclaren Medicaid |
$53.08
|
| Rate for Payer: Mclaren Medicaid |
$53.08
|
| Rate for Payer: Mclaren Medicare |
$53.08
|
| Rate for Payer: Mclaren Medicare |
$53.08
|
| Rate for Payer: Mclaren Medicare |
$53.08
|
| Rate for Payer: Mclaren Medicare |
$53.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.73
|
| Rate for Payer: Meridian Medicaid |
$29.15
|
| Rate for Payer: Meridian Medicaid |
$29.15
|
| Rate for Payer: Meridian Medicaid |
$29.15
|
| Rate for Payer: Meridian Medicaid |
$29.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.40
|
| Rate for Payer: Nomi Health Commercial |
$198.24
|
| Rate for Payer: Nomi Health Commercial |
$228.51
|
| Rate for Payer: Nomi Health Commercial |
$193.00
|
| Rate for Payer: Nomi Health Commercial |
$232.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.52
|
| Rate for Payer: PACE Medicare |
$50.43
|
| Rate for Payer: PACE Medicare |
$50.43
|
| Rate for Payer: PACE Medicare |
$50.43
|
| Rate for Payer: PACE Medicare |
$50.43
|
| Rate for Payer: PACE SWMI |
$53.08
|
| Rate for Payer: PACE SWMI |
$53.08
|
| Rate for Payer: PACE SWMI |
$53.08
|
| Rate for Payer: PACE SWMI |
$53.08
|
| Rate for Payer: PHP Commercial |
$58.39
|
| Rate for Payer: PHP Commercial |
$58.39
|
| Rate for Payer: PHP Commercial |
$58.39
|
| Rate for Payer: PHP Commercial |
$58.39
|
| Rate for Payer: PHP Medicaid |
$28.45
|
| Rate for Payer: PHP Medicaid |
$28.45
|
| Rate for Payer: PHP Medicaid |
$28.45
|
| Rate for Payer: PHP Medicaid |
$28.45
|
| Rate for Payer: PHP Medicare Advantage |
$53.08
|
| Rate for Payer: PHP Medicare Advantage |
$53.08
|
| Rate for Payer: PHP Medicare Advantage |
$53.08
|
| Rate for Payer: PHP Medicare Advantage |
$53.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$45.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$45.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$45.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$45.90
|
| Rate for Payer: Priority Health Medicare |
$53.08
|
| Rate for Payer: Priority Health Medicare |
$53.08
|
| Rate for Payer: Priority Health Medicare |
$53.08
|
| Rate for Payer: Priority Health Medicare |
$53.08
|
| Rate for Payer: Priority Health Narrow Network |
$36.72
|
| Rate for Payer: Priority Health Narrow Network |
$36.72
|
| Rate for Payer: Priority Health Narrow Network |
$36.72
|
| Rate for Payer: Priority Health Narrow Network |
$36.72
|
| Rate for Payer: Railroad Medicare Medicare |
$53.08
|
| Rate for Payer: Railroad Medicare Medicare |
$53.08
|
| Rate for Payer: Railroad Medicare Medicare |
$53.08
|
| Rate for Payer: Railroad Medicare Medicare |
$53.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$53.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$53.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$53.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$53.08
|
| Rate for Payer: UHC Exchange |
$82.27
|
| Rate for Payer: UHC Exchange |
$82.27
|
| Rate for Payer: UHC Exchange |
$82.27
|
| Rate for Payer: UHC Exchange |
$82.27
|
| Rate for Payer: UHC Medicaid |
$27.76
|
| Rate for Payer: UHC Medicaid |
$27.76
|
| Rate for Payer: UHC Medicaid |
$27.76
|
| Rate for Payer: UHC Medicaid |
$27.76
|
| Rate for Payer: UHCCP DNSP |
$53.08
|
| Rate for Payer: UHCCP DNSP |
$53.08
|
| Rate for Payer: UHCCP DNSP |
$53.08
|
| Rate for Payer: UHCCP DNSP |
$53.08
|
| Rate for Payer: UHCCP Medicaid |
$27.76
|
| Rate for Payer: UHCCP Medicaid |
$27.76
|
| Rate for Payer: UHCCP Medicaid |
$27.76
|
| Rate for Payer: UHCCP Medicaid |
$27.76
|
| Rate for Payer: VA VA |
$53.08
|
| Rate for Payer: VA VA |
$53.08
|
| Rate for Payer: VA VA |
$53.08
|
| Rate for Payer: VA VA |
$53.08
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$3.36
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: Aetna Commercial |
$3.93
|
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Commercial |
$1.92
|
| Rate for Payer: Aetna Commercial |
$3.17
|
| Rate for Payer: Aetna Medicare |
$1.62
|
| Rate for Payer: Aetna Medicare |
$0.79
|
| Rate for Payer: Aetna Medicare |
$1.30
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: Aetna Medicare |
$0.94
|
| Rate for Payer: ASR ASR |
$3.26
|
| Rate for Payer: ASR ASR |
$4.24
|
| Rate for Payer: ASR ASR |
$3.42
|
| Rate for Payer: ASR ASR |
$2.46
|
| Rate for Payer: ASR ASR |
$2.07
|
| Rate for Payer: BCBS Complete |
$1.41
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: BCBS Complete |
$1.35
|
| Rate for Payer: BCBS Complete |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$1.76
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.91
|
| Rate for Payer: BCBS Trust/PPO |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$2.77
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Commercial |
$1.76
|
| Rate for Payer: BCN Commercial |
$3.60
|
| Rate for Payer: BCN Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$2.01
|
| Rate for Payer: Cofinity Commercial |
$4.11
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Healthscope Commercial |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$4.24
|
| Rate for Payer: Healthscope Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$3.42
|
| Rate for Payer: Healthscope Whirlpool |
$3.36
|
| Rate for Payer: Healthscope Whirlpool |
$2.14
|
| Rate for Payer: Healthscope Whirlpool |
$2.54
|
| Rate for Payer: Healthscope Whirlpool |
$4.37
|
| Rate for Payer: Healthscope Whirlpool |
$3.52
|
| Rate for Payer: Mclaren Commercial |
$2.28
|
| Rate for Payer: Mclaren Commercial |
$1.92
|
| Rate for Payer: Mclaren Commercial |
$3.93
|
| Rate for Payer: Mclaren Commercial |
$3.17
|
| Rate for Payer: Mclaren Commercial |
$3.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Nomi Health Commercial |
$2.08
|
| Rate for Payer: Nomi Health Commercial |
$1.75
|
| Rate for Payer: Nomi Health Commercial |
$3.58
|
| Rate for Payer: Nomi Health Commercial |
$2.89
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.96
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$4.37
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna Commercial |
$3.93
|
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: Aetna Commercial |
$3.17
|
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Commercial |
$1.92
|
| Rate for Payer: ASR ASR |
$3.26
|
| Rate for Payer: ASR ASR |
$2.07
|
| Rate for Payer: ASR ASR |
$4.24
|
| Rate for Payer: ASR ASR |
$2.46
|
| Rate for Payer: ASR ASR |
$3.42
|
| Rate for Payer: BCBS Trust/PPO |
$3.59
|
| Rate for Payer: BCBS Trust/PPO |
$2.08
|
| Rate for Payer: BCBS Trust/PPO |
$1.76
|
| Rate for Payer: BCBS Trust/PPO |
$2.89
|
| Rate for Payer: BCBS Trust/PPO |
$2.76
|
| Rate for Payer: BCN Commercial |
$2.76
|
| Rate for Payer: BCN Commercial |
$2.08
|
| Rate for Payer: BCN Commercial |
$2.89
|
| Rate for Payer: BCN Commercial |
$3.59
|
| Rate for Payer: BCN Commercial |
$1.76
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Cofinity Commercial |
$2.01
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Cofinity Commercial |
$4.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$3.42
|
| Rate for Payer: Healthscope Commercial |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$4.24
|
| Rate for Payer: Healthscope Whirlpool |
$3.52
|
| Rate for Payer: Healthscope Whirlpool |
$4.37
|
| Rate for Payer: Healthscope Whirlpool |
$2.14
|
| Rate for Payer: Healthscope Whirlpool |
$2.54
|
| Rate for Payer: Healthscope Whirlpool |
$3.36
|
| Rate for Payer: Mclaren Commercial |
$2.28
|
| Rate for Payer: Mclaren Commercial |
$3.17
|
| Rate for Payer: Mclaren Commercial |
$1.92
|
| Rate for Payer: Mclaren Commercial |
$3.93
|
| Rate for Payer: Mclaren Commercial |
$3.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: Nomi Health Commercial |
$2.89
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: Nomi Health Commercial |
$2.08
|
| Rate for Payer: Nomi Health Commercial |
$1.75
|
| Rate for Payer: Nomi Health Commercial |
$3.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.88
|
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$3.35
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
115221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: ASR ASR |
$3.25
|
| Rate for Payer: BCBS Complete |
$1.34
|
| Rate for Payer: BCBS Trust/PPO |
$2.77
|
| Rate for Payer: BCN Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$2.68
|
| Rate for Payer: Cash Price |
$2.68
|
| Rate for Payer: Cofinity Commercial |
$3.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$3.25
|
| Rate for Payer: Healthscope Whirlpool |
$3.35
|
| Rate for Payer: Mclaren Commercial |
$3.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.85
|
| Rate for Payer: Nomi Health Commercial |
$2.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.27
|
| Rate for Payer: Priority Health Narrow Network |
$0.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.95
|
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$3.35
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
115221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: ASR ASR |
$3.25
|
| Rate for Payer: BCBS Trust/PPO |
$2.75
|
| Rate for Payer: BCN Commercial |
$2.75
|
| Rate for Payer: Cash Price |
$2.68
|
| Rate for Payer: Cofinity Commercial |
$3.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$3.25
|
| Rate for Payer: Healthscope Whirlpool |
$3.35
|
| Rate for Payer: Mclaren Commercial |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.85
|
| Rate for Payer: Nomi Health Commercial |
$2.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.95
|
|
|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$166.20
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
251
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$124.65 |
| Max. Negotiated Rate |
$166.20 |
| Rate for Payer: Aetna Commercial |
$149.58
|
| Rate for Payer: ASR ASR |
$161.22
|
| Rate for Payer: BCBS Trust/PPO |
$136.49
|
| Rate for Payer: BCN Commercial |
$136.49
|
| Rate for Payer: Cash Price |
$132.96
|
| Rate for Payer: Cofinity Commercial |
$156.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.96
|
| Rate for Payer: Healthscope Commercial |
$161.22
|
| Rate for Payer: Healthscope Whirlpool |
$166.20
|
| Rate for Payer: Mclaren Commercial |
$149.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.27
|
| Rate for Payer: Nomi Health Commercial |
$136.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.26
|
|
|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$166.20
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
251
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$166.20 |
| Rate for Payer: Aetna Commercial |
$149.58
|
| Rate for Payer: Aetna Medicare |
$61.50
|
| Rate for Payer: ASR ASR |
$161.22
|
| Rate for Payer: BCBS Complete |
$66.48
|
| Rate for Payer: BCBS Trust/PPO |
$137.04
|
| Rate for Payer: BCN Commercial |
$137.04
|
| Rate for Payer: Cash Price |
$132.96
|
| Rate for Payer: Cash Price |
$132.96
|
| Rate for Payer: Cofinity Commercial |
$156.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.96
|
| Rate for Payer: Healthscope Commercial |
$161.22
|
| Rate for Payer: Healthscope Whirlpool |
$166.20
|
| Rate for Payer: Mclaren Commercial |
$149.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.27
|
| Rate for Payer: Nomi Health Commercial |
$136.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.27
|
| Rate for Payer: Priority Health Narrow Network |
$0.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.26
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$116.90
|
|
|
Service Code
|
NDC 781729685
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.67 |
| Max. Negotiated Rate |
$116.90 |
| Rate for Payer: Aetna Commercial |
$105.21
|
| Rate for Payer: ASR ASR |
$113.39
|
| Rate for Payer: BCBS Trust/PPO |
$96.00
|
| Rate for Payer: BCN Commercial |
$96.00
|
| Rate for Payer: Cash Price |
$93.52
|
| Rate for Payer: Cofinity Commercial |
$109.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.52
|
| Rate for Payer: Healthscope Commercial |
$113.39
|
| Rate for Payer: Healthscope Whirlpool |
$116.90
|
| Rate for Payer: Mclaren Commercial |
$105.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.36
|
| Rate for Payer: Nomi Health Commercial |
$95.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.87
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$109.20
|
|
|
Service Code
|
NDC 9900001169
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$109.20 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Medicare |
$40.40
|
| Rate for Payer: ASR ASR |
$105.92
|
| Rate for Payer: BCBS Complete |
$43.68
|
| Rate for Payer: BCBS Trust/PPO |
$90.04
|
| Rate for Payer: BCN Commercial |
$90.04
|
| Rate for Payer: Cash Price |
$87.36
|
| Rate for Payer: Cofinity Commercial |
$102.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.36
|
| Rate for Payer: Healthscope Commercial |
$105.92
|
| Rate for Payer: Healthscope Whirlpool |
$109.20
|
| Rate for Payer: Mclaren Commercial |
$98.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.82
|
| Rate for Payer: Nomi Health Commercial |
$89.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$95.68
|
| Rate for Payer: Priority Health Narrow Network |
$76.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.10
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$109.20
|
|
|
Service Code
|
NDC 9900001169
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$109.20 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: ASR ASR |
$105.92
|
| Rate for Payer: BCBS Trust/PPO |
$89.68
|
| Rate for Payer: BCN Commercial |
$89.68
|
| Rate for Payer: Cash Price |
$87.36
|
| Rate for Payer: Cofinity Commercial |
$102.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.36
|
| Rate for Payer: Healthscope Commercial |
$105.92
|
| Rate for Payer: Healthscope Whirlpool |
$109.20
|
| Rate for Payer: Mclaren Commercial |
$98.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.82
|
| Rate for Payer: Nomi Health Commercial |
$89.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.10
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$153.30
|
|
|
Service Code
|
NDC 68180096301
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.72 |
| Max. Negotiated Rate |
$153.30 |
| Rate for Payer: Aetna Commercial |
$137.97
|
| Rate for Payer: Aetna Medicare |
$56.72
|
| Rate for Payer: ASR ASR |
$148.70
|
| Rate for Payer: BCBS Complete |
$61.32
|
| Rate for Payer: BCBS Trust/PPO |
$126.40
|
| Rate for Payer: BCN Commercial |
$126.40
|
| Rate for Payer: Cash Price |
$122.64
|
| Rate for Payer: Cofinity Commercial |
$144.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.64
|
| Rate for Payer: Healthscope Commercial |
$148.70
|
| Rate for Payer: Healthscope Whirlpool |
$153.30
|
| Rate for Payer: Mclaren Commercial |
$137.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.31
|
| Rate for Payer: Nomi Health Commercial |
$125.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$134.32
|
| Rate for Payer: Priority Health Narrow Network |
$107.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.90
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$116.90
|
|
|
Service Code
|
NDC 781729685
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$116.90 |
| Rate for Payer: Aetna Commercial |
$105.21
|
| Rate for Payer: Aetna Medicare |
$43.25
|
| Rate for Payer: ASR ASR |
$113.39
|
| Rate for Payer: BCBS Complete |
$46.76
|
| Rate for Payer: BCBS Trust/PPO |
$96.38
|
| Rate for Payer: BCN Commercial |
$96.38
|
| Rate for Payer: Cash Price |
$93.52
|
| Rate for Payer: Cofinity Commercial |
$109.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.52
|
| Rate for Payer: Healthscope Commercial |
$113.39
|
| Rate for Payer: Healthscope Whirlpool |
$116.90
|
| Rate for Payer: Mclaren Commercial |
$105.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.36
|
| Rate for Payer: Nomi Health Commercial |
$95.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$102.43
|
| Rate for Payer: Priority Health Narrow Network |
$81.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.87
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$153.30
|
|
|
Service Code
|
NDC 68180096301
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.97 |
| Max. Negotiated Rate |
$153.30 |
| Rate for Payer: Aetna Commercial |
$137.97
|
| Rate for Payer: ASR ASR |
$148.70
|
| Rate for Payer: BCBS Trust/PPO |
$125.89
|
| Rate for Payer: BCN Commercial |
$125.89
|
| Rate for Payer: Cash Price |
$122.64
|
| Rate for Payer: Cofinity Commercial |
$144.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.64
|
| Rate for Payer: Healthscope Commercial |
$148.70
|
| Rate for Payer: Healthscope Whirlpool |
$153.30
|
| Rate for Payer: Mclaren Commercial |
$137.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.31
|
| Rate for Payer: Nomi Health Commercial |
$125.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.90
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$6,189.00
|
|
|
Service Code
|
APR-DRG 7753
|
| Min. Negotiated Rate |
$5,595.59 |
| Max. Negotiated Rate |
$6,189.00 |
| Rate for Payer: BCBS Complete |
$6,189.00
|
| Rate for Payer: Mclaren Medicaid |
$5,894.28
|
| Rate for Payer: Meridian Medicaid |
$6,189.00
|
| Rate for Payer: PHP Medicaid |
$5,595.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,894.28
|
| Rate for Payer: UHC Medicaid |
$5,894.28
|
| Rate for Payer: UHCCP Medicaid |
$5,894.28
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$12,500.61
|
|
|
Service Code
|
APR-DRG 7754
|
| Min. Negotiated Rate |
$11,302.05 |
| Max. Negotiated Rate |
$12,500.61 |
| Rate for Payer: BCBS Complete |
$12,500.61
|
| Rate for Payer: Mclaren Medicaid |
$11,905.34
|
| Rate for Payer: Meridian Medicaid |
$12,500.61
|
| Rate for Payer: PHP Medicaid |
$11,302.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,905.34
|
| Rate for Payer: UHC Medicaid |
$11,905.34
|
| Rate for Payer: UHCCP Medicaid |
$11,905.34
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$3,062.62
|
|
|
Service Code
|
APR-DRG 7751
|
| Min. Negotiated Rate |
$2,768.97 |
| Max. Negotiated Rate |
$3,062.62 |
| Rate for Payer: BCBS Complete |
$3,062.62
|
| Rate for Payer: Mclaren Medicaid |
$2,916.78
|
| Rate for Payer: Meridian Medicaid |
$3,062.62
|
| Rate for Payer: PHP Medicaid |
$2,768.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,916.78
|
| Rate for Payer: UHC Medicaid |
$2,916.78
|
| Rate for Payer: UHCCP Medicaid |
$2,916.78
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$3,750.89
|
|
|
Service Code
|
APR-DRG 7752
|
| Min. Negotiated Rate |
$3,391.25 |
| Max. Negotiated Rate |
$3,750.89 |
| Rate for Payer: BCBS Complete |
$3,750.89
|
| Rate for Payer: Mclaren Medicaid |
$3,572.28
|
| Rate for Payer: Meridian Medicaid |
$3,750.89
|
| Rate for Payer: PHP Medicaid |
$3,391.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,572.28
|
| Rate for Payer: UHC Medicaid |
$3,572.28
|
| Rate for Payer: UHCCP Medicaid |
$3,572.28
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA
|
Facility
|
IP
|
$9,605.21
|
|
|
Service Code
|
MSDRG 894
|
| Min. Negotiated Rate |
$5,887.06 |
| Max. Negotiated Rate |
$9,605.21 |
| Rate for Payer: Aetna Medicare |
$6,196.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,746.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,746.14
|
| Rate for Payer: BCBS MAPPO |
$6,196.91
|
| Rate for Payer: BCN Medicare Advantage |
$6,196.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,196.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,196.91
|
| Rate for Payer: Mclaren Medicare |
$6,196.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,506.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,126.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,816.60
|
| Rate for Payer: PACE Medicare |
$5,887.06
|
| Rate for Payer: PACE SWMI |
$6,196.91
|
| Rate for Payer: PHP Commercial |
$6,816.60
|
| Rate for Payer: PHP Medicare Advantage |
$6,196.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8,475.47
|
| Rate for Payer: Priority Health Medicare |
$6,196.91
|
| Rate for Payer: Priority Health Narrow Network |
$6,780.37
|
| Rate for Payer: Railroad Medicare Medicare |
$6,196.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,196.91
|
| Rate for Payer: UHC Exchange |
$9,605.21
|
| Rate for Payer: UHCCP DNSP |
$6,196.91
|
| Rate for Payer: VA VA |
$6,196.91
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC
|
Facility
|
IP
|
$23,975.58
|
|
|
Service Code
|
MSDRG 896
|
| Min. Negotiated Rate |
$13,605.28 |
| Max. Negotiated Rate |
$23,975.58 |
| Rate for Payer: Aetna Medicare |
$14,321.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,901.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,901.69
|
| Rate for Payer: BCBS MAPPO |
$14,321.35
|
| Rate for Payer: BCN Medicare Advantage |
$14,321.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,321.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,321.35
|
| Rate for Payer: Mclaren Medicare |
$14,321.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,037.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,469.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,753.49
|
| Rate for Payer: PACE Medicare |
$13,605.28
|
| Rate for Payer: PACE SWMI |
$14,321.35
|
| Rate for Payer: PHP Commercial |
$15,753.49
|
| Rate for Payer: PHP Medicare Advantage |
$14,321.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23,975.58
|
| Rate for Payer: Priority Health Medicare |
$14,321.35
|
| Rate for Payer: Priority Health Narrow Network |
$19,180.46
|
| Rate for Payer: Railroad Medicare Medicare |
$14,321.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,321.35
|
| Rate for Payer: UHC Exchange |
$22,198.09
|
| Rate for Payer: UHCCP DNSP |
$14,321.35
|
| Rate for Payer: VA VA |
$14,321.35
|
|
