|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$2.89
|
|
|
Service Code
|
NDC 50268052411
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: ASR ASR |
$2.80
|
| Rate for Payer: BCBS Trust/PPO |
$2.37
|
| Rate for Payer: BCN Commercial |
$2.37
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Healthscope Whirlpool |
$2.89
|
| Rate for Payer: Mclaren Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Nomi Health Commercial |
$2.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.54
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
OP
|
$131.60
|
|
|
Service Code
|
NDC 20555003600
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$131.60 |
| Rate for Payer: Aetna Commercial |
$118.44
|
| Rate for Payer: Aetna Medicare |
$48.69
|
| Rate for Payer: ASR ASR |
$127.65
|
| Rate for Payer: BCBS Complete |
$52.64
|
| Rate for Payer: BCBS Trust/PPO |
$108.50
|
| Rate for Payer: BCN Commercial |
$108.50
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$123.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$127.65
|
| Rate for Payer: Healthscope Whirlpool |
$131.60
|
| Rate for Payer: Mclaren Commercial |
$118.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Nomi Health Commercial |
$107.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$115.31
|
| Rate for Payer: Priority Health Narrow Network |
$92.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.81
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$1,530.47
|
|
|
Service Code
|
NDC 456321060
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,147.85 |
| Max. Negotiated Rate |
$1,530.47 |
| Rate for Payer: Aetna Commercial |
$1,377.42
|
| Rate for Payer: ASR ASR |
$1,484.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,256.82
|
| Rate for Payer: BCN Commercial |
$1,256.82
|
| Rate for Payer: Cash Price |
$1,224.37
|
| Rate for Payer: Cofinity Commercial |
$1,438.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.37
|
| Rate for Payer: Healthscope Commercial |
$1,484.55
|
| Rate for Payer: Healthscope Whirlpool |
$1,530.47
|
| Rate for Payer: Mclaren Commercial |
$1,377.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,300.90
|
| Rate for Payer: Nomi Health Commercial |
$1,254.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,147.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,346.81
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$275.50
|
|
|
Service Code
|
NDC 904650661
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Aetna Commercial |
$247.95
|
| Rate for Payer: Aetna Medicare |
$101.94
|
| Rate for Payer: ASR ASR |
$267.24
|
| Rate for Payer: BCBS Complete |
$110.20
|
| Rate for Payer: BCBS Trust/PPO |
$227.15
|
| Rate for Payer: BCN Commercial |
$227.15
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cofinity Commercial |
$258.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Healthscope Commercial |
$267.24
|
| Rate for Payer: Healthscope Whirlpool |
$275.50
|
| Rate for Payer: Mclaren Commercial |
$247.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$220.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: Nomi Health Commercial |
$225.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$241.39
|
| Rate for Payer: Priority Health Narrow Network |
$193.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.44
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$1,530.47
|
|
|
Service Code
|
NDC 456321060
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$566.27 |
| Max. Negotiated Rate |
$1,530.47 |
| Rate for Payer: Aetna Commercial |
$1,377.42
|
| Rate for Payer: Aetna Medicare |
$566.27
|
| Rate for Payer: ASR ASR |
$1,484.55
|
| Rate for Payer: BCBS Complete |
$612.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,261.87
|
| Rate for Payer: BCN Commercial |
$1,261.87
|
| Rate for Payer: Cash Price |
$1,224.37
|
| Rate for Payer: Cofinity Commercial |
$1,438.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.37
|
| Rate for Payer: Healthscope Commercial |
$1,484.55
|
| Rate for Payer: Healthscope Whirlpool |
$1,530.47
|
| Rate for Payer: Mclaren Commercial |
$1,377.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,224.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,300.90
|
| Rate for Payer: Nomi Health Commercial |
$1,254.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,147.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,341.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,072.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,346.81
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$25.51
|
|
|
Service Code
|
NDC 456321011
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$20.94
|
| Rate for Payer: BCN Commercial |
$20.94
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$24.74
|
| Rate for Payer: Healthscope Whirlpool |
$25.50
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$275.50
|
|
|
Service Code
|
NDC 904650661
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.62 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Aetna Commercial |
$247.95
|
| Rate for Payer: ASR ASR |
$267.24
|
| Rate for Payer: BCBS Trust/PPO |
$226.24
|
| Rate for Payer: BCN Commercial |
$226.24
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cofinity Commercial |
$258.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Healthscope Commercial |
$267.24
|
| Rate for Payer: Healthscope Whirlpool |
$275.50
|
| Rate for Payer: Mclaren Commercial |
$247.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: Nomi Health Commercial |
$225.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.44
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$368.60
|
|
|
Service Code
|
NDC 591387544
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.38 |
| Max. Negotiated Rate |
$368.60 |
| Rate for Payer: Aetna Commercial |
$331.74
|
| Rate for Payer: Aetna Medicare |
$136.38
|
| Rate for Payer: ASR ASR |
$357.54
|
| Rate for Payer: BCBS Complete |
$147.44
|
| Rate for Payer: BCBS Trust/PPO |
$303.91
|
| Rate for Payer: BCN Commercial |
$303.91
|
| Rate for Payer: Cash Price |
$294.88
|
| Rate for Payer: Cofinity Commercial |
$346.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.88
|
| Rate for Payer: Healthscope Commercial |
$357.54
|
| Rate for Payer: Healthscope Whirlpool |
$368.60
|
| Rate for Payer: Mclaren Commercial |
$331.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$294.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.31
|
| Rate for Payer: Nomi Health Commercial |
$302.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$322.97
|
| Rate for Payer: Priority Health Narrow Network |
$258.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$324.37
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$368.60
|
|
|
Service Code
|
NDC 591387544
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$276.45 |
| Max. Negotiated Rate |
$368.60 |
| Rate for Payer: Aetna Commercial |
$331.74
|
| Rate for Payer: ASR ASR |
$357.54
|
| Rate for Payer: BCBS Trust/PPO |
$302.69
|
| Rate for Payer: BCN Commercial |
$302.69
|
| Rate for Payer: Cash Price |
$294.88
|
| Rate for Payer: Cofinity Commercial |
$346.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.88
|
| Rate for Payer: Healthscope Commercial |
$357.54
|
| Rate for Payer: Healthscope Whirlpool |
$368.60
|
| Rate for Payer: Mclaren Commercial |
$331.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.31
|
| Rate for Payer: Nomi Health Commercial |
$302.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$324.37
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 591387545
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Aetna Medicare |
$1.36
|
| Rate for Payer: ASR ASR |
$3.58
|
| Rate for Payer: BCBS Complete |
$1.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.04
|
| Rate for Payer: BCN Commercial |
$3.04
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$3.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.58
|
| Rate for Payer: Healthscope Whirlpool |
$3.69
|
| Rate for Payer: Mclaren Commercial |
$3.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.13
|
| Rate for Payer: Nomi Health Commercial |
$3.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.23
|
| Rate for Payer: Priority Health Narrow Network |
$2.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.24
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 591387545
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: ASR ASR |
$3.58
|
| Rate for Payer: BCBS Trust/PPO |
$3.03
|
| Rate for Payer: BCN Commercial |
$3.03
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$3.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.58
|
| Rate for Payer: Healthscope Whirlpool |
$3.69
|
| Rate for Payer: Mclaren Commercial |
$3.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.13
|
| Rate for Payer: Nomi Health Commercial |
$3.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.24
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$25.51
|
|
|
Service Code
|
NDC 456321011
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna Medicare |
$9.44
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$21.03
|
| Rate for Payer: BCN Commercial |
$21.03
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$24.74
|
| Rate for Payer: Healthscope Whirlpool |
$25.50
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.35
|
| Rate for Payer: Priority Health Narrow Network |
$17.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION
|
Facility
|
OP
|
$401.04
|
|
|
Service Code
|
HCPCS 90619
|
| Hospital Charge Code |
194943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$148.39 |
| Max. Negotiated Rate |
$401.04 |
| Rate for Payer: Aetna Commercial |
$360.94
|
| Rate for Payer: Aetna Commercial |
$342.32
|
| Rate for Payer: Aetna Medicare |
$140.73
|
| Rate for Payer: Aetna Medicare |
$148.39
|
| Rate for Payer: ASR ASR |
$389.01
|
| Rate for Payer: ASR ASR |
$368.94
|
| Rate for Payer: BCBS Complete |
$152.14
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS Trust/PPO |
$330.66
|
| Rate for Payer: BCBS Trust/PPO |
$313.60
|
| Rate for Payer: BCN Commercial |
$313.60
|
| Rate for Payer: BCN Commercial |
$330.66
|
| Rate for Payer: Cash Price |
$320.84
|
| Rate for Payer: Cash Price |
$304.28
|
| Rate for Payer: Cash Price |
$320.84
|
| Rate for Payer: Cash Price |
$304.28
|
| Rate for Payer: Cofinity Commercial |
$357.53
|
| Rate for Payer: Cofinity Commercial |
$376.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.28
|
| Rate for Payer: Healthscope Commercial |
$389.01
|
| Rate for Payer: Healthscope Commercial |
$368.94
|
| Rate for Payer: Healthscope Whirlpool |
$401.04
|
| Rate for Payer: Healthscope Whirlpool |
$380.36
|
| Rate for Payer: Mclaren Commercial |
$360.94
|
| Rate for Payer: Mclaren Commercial |
$342.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$304.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.89
|
| Rate for Payer: Nomi Health Commercial |
$311.89
|
| Rate for Payer: Nomi Health Commercial |
$328.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$201.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$201.76
|
| Rate for Payer: Priority Health Narrow Network |
$161.41
|
| Rate for Payer: Priority Health Narrow Network |
$161.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$334.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.92
|
|
|
MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION
|
Facility
|
IP
|
$380.36
|
|
|
Service Code
|
HCPCS 90619
|
| Hospital Charge Code |
194943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$285.27 |
| Max. Negotiated Rate |
$380.36 |
| Rate for Payer: Aetna Commercial |
$342.32
|
| Rate for Payer: Aetna Commercial |
$360.94
|
| Rate for Payer: ASR ASR |
$389.01
|
| Rate for Payer: ASR ASR |
$368.94
|
| Rate for Payer: BCBS Trust/PPO |
$329.34
|
| Rate for Payer: BCBS Trust/PPO |
$312.35
|
| Rate for Payer: BCN Commercial |
$329.34
|
| Rate for Payer: BCN Commercial |
$312.35
|
| Rate for Payer: Cash Price |
$320.84
|
| Rate for Payer: Cash Price |
$304.28
|
| Rate for Payer: Cofinity Commercial |
$357.53
|
| Rate for Payer: Cofinity Commercial |
$376.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.28
|
| Rate for Payer: Healthscope Commercial |
$368.94
|
| Rate for Payer: Healthscope Commercial |
$389.01
|
| Rate for Payer: Healthscope Whirlpool |
$401.04
|
| Rate for Payer: Healthscope Whirlpool |
$380.36
|
| Rate for Payer: Mclaren Commercial |
$360.94
|
| Rate for Payer: Mclaren Commercial |
$342.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.30
|
| Rate for Payer: Nomi Health Commercial |
$328.86
|
| Rate for Payer: Nomi Health Commercial |
$311.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$334.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.92
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
|
Facility
|
IP
|
$11,651.58
|
|
|
Service Code
|
APR-DRG 5324
|
| Min. Negotiated Rate |
$10,534.42 |
| Max. Negotiated Rate |
$11,651.58 |
| Rate for Payer: BCBS Complete |
$11,651.58
|
| Rate for Payer: Mclaren Medicaid |
$11,096.74
|
| Rate for Payer: Meridian Medicaid |
$11,651.58
|
| Rate for Payer: PHP Medicaid |
$10,534.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,096.74
|
| Rate for Payer: UHC Medicaid |
$11,096.74
|
| Rate for Payer: UHCCP Medicaid |
$11,096.74
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
|
Facility
|
IP
|
$3,034.28
|
|
|
Service Code
|
APR-DRG 5322
|
| Min. Negotiated Rate |
$2,743.35 |
| Max. Negotiated Rate |
$3,034.28 |
| Rate for Payer: BCBS Complete |
$3,034.28
|
| Rate for Payer: Mclaren Medicaid |
$2,889.79
|
| Rate for Payer: Meridian Medicaid |
$3,034.28
|
| Rate for Payer: PHP Medicaid |
$2,743.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,889.79
|
| Rate for Payer: UHC Medicaid |
$2,889.79
|
| Rate for Payer: UHCCP Medicaid |
$2,889.79
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
|
Facility
|
IP
|
$2,199.42
|
|
|
Service Code
|
APR-DRG 5321
|
| Min. Negotiated Rate |
$1,988.54 |
| Max. Negotiated Rate |
$2,199.42 |
| Rate for Payer: BCBS Complete |
$2,199.42
|
| Rate for Payer: Mclaren Medicaid |
$2,094.68
|
| Rate for Payer: Meridian Medicaid |
$2,199.42
|
| Rate for Payer: PHP Medicaid |
$1,988.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,094.68
|
| Rate for Payer: UHC Medicaid |
$2,094.68
|
| Rate for Payer: UHCCP Medicaid |
$2,094.68
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
|
Facility
|
IP
|
$6,232.05
|
|
|
Service Code
|
APR-DRG 5323
|
| Min. Negotiated Rate |
$5,634.52 |
| Max. Negotiated Rate |
$6,232.05 |
| Rate for Payer: BCBS Complete |
$6,232.05
|
| Rate for Payer: Mclaren Medicaid |
$5,935.28
|
| Rate for Payer: Meridian Medicaid |
$6,232.05
|
| Rate for Payer: PHP Medicaid |
$5,634.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,935.28
|
| Rate for Payer: UHC Medicaid |
$5,935.28
|
| Rate for Payer: UHCCP Medicaid |
$5,935.28
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$13,965.05
|
|
|
Service Code
|
MSDRG 760
|
| Min. Negotiated Rate |
$8,559.22 |
| Max. Negotiated Rate |
$13,965.05 |
| Rate for Payer: Aetna Medicare |
$9,009.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,262.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,262.14
|
| Rate for Payer: BCBS MAPPO |
$9,009.71
|
| Rate for Payer: BCN Medicare Advantage |
$9,009.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,009.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,009.71
|
| Rate for Payer: Mclaren Medicare |
$9,009.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,460.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,361.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,910.68
|
| Rate for Payer: PACE Medicare |
$8,559.22
|
| Rate for Payer: PACE SWMI |
$9,009.71
|
| Rate for Payer: PHP Commercial |
$9,910.68
|
| Rate for Payer: PHP Medicare Advantage |
$9,009.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13,841.84
|
| Rate for Payer: Priority Health Medicare |
$9,009.71
|
| Rate for Payer: Priority Health Narrow Network |
$11,073.47
|
| Rate for Payer: Railroad Medicare Medicare |
$9,009.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,009.71
|
| Rate for Payer: UHC Exchange |
$13,965.05
|
| Rate for Payer: UHCCP DNSP |
$9,009.71
|
| Rate for Payer: VA VA |
$9,009.71
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,087.29
|
|
|
Service Code
|
MSDRG 761
|
| Min. Negotiated Rate |
$5,569.63 |
| Max. Negotiated Rate |
$9,087.29 |
| Rate for Payer: Aetna Medicare |
$5,862.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,328.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,328.46
|
| Rate for Payer: BCBS MAPPO |
$5,862.77
|
| Rate for Payer: BCN Medicare Advantage |
$5,862.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,862.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,862.77
|
| Rate for Payer: Mclaren Medicare |
$5,862.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,155.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,742.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,449.05
|
| Rate for Payer: PACE Medicare |
$5,569.63
|
| Rate for Payer: PACE SWMI |
$5,862.77
|
| Rate for Payer: PHP Commercial |
$6,449.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,862.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,837.99
|
| Rate for Payer: Priority Health Medicare |
$5,862.77
|
| Rate for Payer: Priority Health Narrow Network |
$6,270.39
|
| Rate for Payer: Railroad Medicare Medicare |
$5,862.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,862.77
|
| Rate for Payer: UHC Exchange |
$9,087.29
|
| Rate for Payer: UHCCP DNSP |
$5,862.77
|
| Rate for Payer: VA VA |
$5,862.77
|
|
|
MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$31,539.53
|
|
|
Service Code
|
APR-DRG 7404
|
| Min. Negotiated Rate |
$28,515.51 |
| Max. Negotiated Rate |
$31,539.53 |
| Rate for Payer: BCBS Complete |
$31,539.53
|
| Rate for Payer: Mclaren Medicaid |
$30,037.64
|
| Rate for Payer: Meridian Medicaid |
$31,539.53
|
| Rate for Payer: PHP Medicaid |
$28,515.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$30,037.64
|
| Rate for Payer: UHC Medicaid |
$30,037.64
|
| Rate for Payer: UHCCP Medicaid |
$30,037.64
|
|
|
MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$9,088.68
|
|
|
Service Code
|
APR-DRG 7402
|
| Min. Negotiated Rate |
$8,217.25 |
| Max. Negotiated Rate |
$9,088.68 |
| Rate for Payer: BCBS Complete |
$9,088.68
|
| Rate for Payer: Mclaren Medicaid |
$8,655.88
|
| Rate for Payer: Meridian Medicaid |
$9,088.68
|
| Rate for Payer: PHP Medicaid |
$8,217.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,655.88
|
| Rate for Payer: UHC Medicaid |
$8,655.88
|
| Rate for Payer: UHCCP Medicaid |
$8,655.88
|
|
|
MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$16,844.40
|
|
|
Service Code
|
APR-DRG 7403
|
| Min. Negotiated Rate |
$15,229.36 |
| Max. Negotiated Rate |
$16,844.40 |
| Rate for Payer: BCBS Complete |
$16,844.40
|
| Rate for Payer: Mclaren Medicaid |
$16,042.29
|
| Rate for Payer: Meridian Medicaid |
$16,844.40
|
| Rate for Payer: PHP Medicaid |
$15,229.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,042.29
|
| Rate for Payer: UHC Medicaid |
$16,042.29
|
| Rate for Payer: UHCCP Medicaid |
$16,042.29
|
|
|
MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$5,406.45
|
|
|
Service Code
|
APR-DRG 7401
|
| Min. Negotiated Rate |
$4,888.08 |
| Max. Negotiated Rate |
$5,406.45 |
| Rate for Payer: BCBS Complete |
$5,406.45
|
| Rate for Payer: Mclaren Medicaid |
$5,149.00
|
| Rate for Payer: Meridian Medicaid |
$5,406.45
|
| Rate for Payer: PHP Medicaid |
$4,888.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,149.00
|
| Rate for Payer: UHC Medicaid |
$5,149.00
|
| Rate for Payer: UHCCP Medicaid |
$5,149.00
|
|
|
MEPOLIZUMAB 100 MG/ML SUBCUTANEOUS AUTO-INJECTOR
|
Facility
|
OP
|
$10,376.55
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
190682
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$10,376.55 |
| Rate for Payer: Aetna Commercial |
$9,338.89
|
| Rate for Payer: Aetna Medicare |
$31.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.77
|
| Rate for Payer: ASR ASR |
$10,065.25
|
| Rate for Payer: BCBS Complete |
$17.48
|
| Rate for Payer: BCBS MAPPO |
$31.82
|
| Rate for Payer: BCBS Trust/PPO |
$8,555.46
|
| Rate for Payer: BCN Commercial |
$8,555.46
|
| Rate for Payer: BCN Medicare Advantage |
$31.82
|
| Rate for Payer: Cash Price |
$8,301.24
|
| Rate for Payer: Cash Price |
$8,301.24
|
| Rate for Payer: Cofinity Commercial |
$9,753.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,301.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$10,065.25
|
| Rate for Payer: Healthscope Whirlpool |
$10,376.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$31.82
|
| Rate for Payer: Mclaren Commercial |
$9,338.89
|
| Rate for Payer: Mclaren Medicaid |
$31.82
|
| Rate for Payer: Mclaren Medicare |
$31.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.41
|
| Rate for Payer: Meridian Medicaid |
$17.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,820.07
|
| Rate for Payer: Nomi Health Commercial |
$8,508.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,782.41
|
| Rate for Payer: PACE Medicare |
$30.23
|
| Rate for Payer: PACE SWMI |
$31.82
|
| Rate for Payer: PHP Commercial |
$35.00
|
| Rate for Payer: PHP Medicaid |
$17.06
|
| Rate for Payer: PHP Medicare Advantage |
$31.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$33.09
|
| Rate for Payer: Priority Health Medicare |
$31.82
|
| Rate for Payer: Priority Health Narrow Network |
$26.47
|
| Rate for Payer: Railroad Medicare Medicare |
$31.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,131.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.82
|
| Rate for Payer: UHC Exchange |
$49.32
|
| Rate for Payer: UHC Medicaid |
$16.64
|
| Rate for Payer: UHCCP DNSP |
$31.82
|
| Rate for Payer: UHCCP Medicaid |
$16.64
|
| Rate for Payer: VA VA |
$31.82
|
|
