|
MINOR BLADDER PROCEDURES WITH MCC
|
Facility
|
IP
|
$42,061.34
|
|
|
Service Code
|
MSDRG 662
|
| Min. Negotiated Rate |
$22,611.02 |
| Max. Negotiated Rate |
$42,061.34 |
| Rate for Payer: Aetna Medicare |
$23,801.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,751.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,751.34
|
| Rate for Payer: BCBS MAPPO |
$23,801.07
|
| Rate for Payer: BCN Medicare Advantage |
$23,801.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,801.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$23,801.07
|
| Rate for Payer: Mclaren Medicare |
$23,801.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24,991.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,371.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$26,181.18
|
| Rate for Payer: PACE Medicare |
$22,611.02
|
| Rate for Payer: PACE SWMI |
$23,801.07
|
| Rate for Payer: PHP Commercial |
$26,181.18
|
| Rate for Payer: PHP Medicare Advantage |
$23,801.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$42,061.34
|
| Rate for Payer: Priority Health Medicare |
$23,801.07
|
| Rate for Payer: Priority Health Narrow Network |
$33,649.07
|
| Rate for Payer: Railroad Medicare Medicare |
$23,801.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23,801.07
|
| Rate for Payer: UHC Exchange |
$36,891.66
|
| Rate for Payer: UHCCP DNSP |
$23,801.07
|
| Rate for Payer: VA VA |
$23,801.07
|
|
|
MINOR BLADDER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$14,404.83
|
|
|
Service Code
|
MSDRG 664
|
| Min. Negotiated Rate |
$8,828.77 |
| Max. Negotiated Rate |
$14,404.83 |
| Rate for Payer: Aetna Medicare |
$9,293.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,616.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,616.80
|
| Rate for Payer: BCBS MAPPO |
$9,293.44
|
| Rate for Payer: BCN Medicare Advantage |
$9,293.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,293.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,293.44
|
| Rate for Payer: Mclaren Medicare |
$9,293.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,758.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,687.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,222.78
|
| Rate for Payer: PACE Medicare |
$8,828.77
|
| Rate for Payer: PACE SWMI |
$9,293.44
|
| Rate for Payer: PHP Commercial |
$10,222.78
|
| Rate for Payer: PHP Medicare Advantage |
$9,293.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,383.15
|
| Rate for Payer: Priority Health Medicare |
$9,293.44
|
| Rate for Payer: Priority Health Narrow Network |
$11,506.52
|
| Rate for Payer: Railroad Medicare Medicare |
$9,293.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,293.44
|
| Rate for Payer: UHC Exchange |
$14,404.83
|
| Rate for Payer: UHCCP DNSP |
$9,293.44
|
| Rate for Payer: VA VA |
$9,293.44
|
|
|
MINOR SKIN DISORDERS WITH MCC
|
Facility
|
IP
|
$20,789.55
|
|
|
Service Code
|
MSDRG 606
|
| Min. Negotiated Rate |
$12,018.81 |
| Max. Negotiated Rate |
$20,789.55 |
| Rate for Payer: Aetna Medicare |
$12,651.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,814.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,814.23
|
| Rate for Payer: BCBS MAPPO |
$12,651.38
|
| Rate for Payer: BCN Medicare Advantage |
$12,651.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,651.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,651.38
|
| Rate for Payer: Mclaren Medicare |
$12,651.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,283.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,549.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,916.52
|
| Rate for Payer: PACE Medicare |
$12,018.81
|
| Rate for Payer: PACE SWMI |
$12,651.38
|
| Rate for Payer: PHP Commercial |
$13,916.52
|
| Rate for Payer: PHP Medicare Advantage |
$12,651.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20,789.55
|
| Rate for Payer: Priority Health Medicare |
$12,651.38
|
| Rate for Payer: Priority Health Narrow Network |
$16,631.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12,651.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,651.38
|
| Rate for Payer: UHC Exchange |
$19,609.64
|
| Rate for Payer: UHCCP DNSP |
$12,651.38
|
| Rate for Payer: VA VA |
$12,651.38
|
|
|
MINOR SKIN DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$12,836.57
|
|
|
Service Code
|
MSDRG 607
|
| Min. Negotiated Rate |
$7,867.58 |
| Max. Negotiated Rate |
$12,836.57 |
| Rate for Payer: Aetna Medicare |
$8,281.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,352.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,352.08
|
| Rate for Payer: BCBS MAPPO |
$8,281.66
|
| Rate for Payer: BCN Medicare Advantage |
$8,281.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,281.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,281.66
|
| Rate for Payer: Mclaren Medicare |
$8,281.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,695.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,523.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,109.83
|
| Rate for Payer: PACE Medicare |
$7,867.58
|
| Rate for Payer: PACE SWMI |
$8,281.66
|
| Rate for Payer: PHP Commercial |
$9,109.83
|
| Rate for Payer: PHP Medicare Advantage |
$8,281.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12,452.85
|
| Rate for Payer: Priority Health Medicare |
$8,281.66
|
| Rate for Payer: Priority Health Narrow Network |
$9,962.28
|
| Rate for Payer: Railroad Medicare Medicare |
$8,281.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,281.66
|
| Rate for Payer: UHC Exchange |
$12,836.57
|
| Rate for Payer: UHCCP DNSP |
$8,281.66
|
| Rate for Payer: VA VA |
$8,281.66
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC
|
Facility
|
IP
|
$20,672.77
|
|
|
Service Code
|
MSDRG 345
|
| Min. Negotiated Rate |
$11,960.66 |
| Max. Negotiated Rate |
$20,672.77 |
| Rate for Payer: Aetna Medicare |
$12,590.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,737.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,737.71
|
| Rate for Payer: BCBS MAPPO |
$12,590.17
|
| Rate for Payer: BCN Medicare Advantage |
$12,590.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,590.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,590.17
|
| Rate for Payer: Mclaren Medicare |
$12,590.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,219.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,478.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,849.19
|
| Rate for Payer: PACE Medicare |
$11,960.66
|
| Rate for Payer: PACE SWMI |
$12,590.17
|
| Rate for Payer: PHP Commercial |
$13,849.19
|
| Rate for Payer: PHP Medicare Advantage |
$12,590.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20,672.77
|
| Rate for Payer: Priority Health Medicare |
$12,590.17
|
| Rate for Payer: Priority Health Narrow Network |
$16,538.22
|
| Rate for Payer: Railroad Medicare Medicare |
$12,590.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,590.17
|
| Rate for Payer: UHC Exchange |
$19,514.76
|
| Rate for Payer: UHCCP DNSP |
$12,590.17
|
| Rate for Payer: VA VA |
$12,590.17
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC
|
Facility
|
IP
|
$35,484.57
|
|
|
Service Code
|
MSDRG 344
|
| Min. Negotiated Rate |
$19,336.15 |
| Max. Negotiated Rate |
$35,484.57 |
| Rate for Payer: Aetna Medicare |
$20,353.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,442.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,442.30
|
| Rate for Payer: BCBS MAPPO |
$20,353.84
|
| Rate for Payer: BCN Medicare Advantage |
$20,353.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,353.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$20,353.84
|
| Rate for Payer: Mclaren Medicare |
$20,353.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,371.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,406.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,389.22
|
| Rate for Payer: PACE Medicare |
$19,336.15
|
| Rate for Payer: PACE SWMI |
$20,353.84
|
| Rate for Payer: PHP Commercial |
$22,389.22
|
| Rate for Payer: PHP Medicare Advantage |
$20,353.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$35,484.57
|
| Rate for Payer: Priority Health Medicare |
$20,353.84
|
| Rate for Payer: Priority Health Narrow Network |
$28,387.66
|
| Rate for Payer: Railroad Medicare Medicare |
$20,353.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,353.84
|
| Rate for Payer: UHC Exchange |
$31,548.45
|
| Rate for Payer: UHCCP DNSP |
$20,353.84
|
| Rate for Payer: VA VA |
$20,353.84
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$16,296.96
|
|
|
Service Code
|
MSDRG 346
|
| Min. Negotiated Rate |
$9,781.74 |
| Max. Negotiated Rate |
$16,296.96 |
| Rate for Payer: Aetna Medicare |
$10,296.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,870.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,870.71
|
| Rate for Payer: BCBS MAPPO |
$10,296.57
|
| Rate for Payer: BCN Medicare Advantage |
$10,296.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,296.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,296.57
|
| Rate for Payer: Mclaren Medicare |
$10,296.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,811.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,841.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,326.23
|
| Rate for Payer: PACE Medicare |
$9,781.74
|
| Rate for Payer: PACE SWMI |
$10,296.57
|
| Rate for Payer: PHP Commercial |
$11,326.23
|
| Rate for Payer: PHP Medicare Advantage |
$10,296.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16,296.96
|
| Rate for Payer: Priority Health Medicare |
$10,296.57
|
| Rate for Payer: Priority Health Narrow Network |
$13,037.57
|
| Rate for Payer: Railroad Medicare Medicare |
$10,296.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,296.57
|
| Rate for Payer: UHC Exchange |
$15,959.68
|
| Rate for Payer: UHCCP DNSP |
$10,296.57
|
| Rate for Payer: VA VA |
$10,296.57
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,583.86
|
|
|
Service Code
|
NDC 469260130
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,187.89 |
| Max. Negotiated Rate |
$1,583.86 |
| Rate for Payer: Aetna Commercial |
$1,425.47
|
| Rate for Payer: ASR ASR |
$1,536.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,300.67
|
| Rate for Payer: BCN Commercial |
$1,300.67
|
| Rate for Payer: Cash Price |
$1,267.09
|
| Rate for Payer: Cofinity Commercial |
$1,488.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,267.09
|
| Rate for Payer: Healthscope Commercial |
$1,536.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,583.86
|
| Rate for Payer: Mclaren Commercial |
$1,425.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,346.28
|
| Rate for Payer: Nomi Health Commercial |
$1,298.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,187.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,393.80
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,583.86
|
|
|
Service Code
|
NDC 469260130
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$586.03 |
| Max. Negotiated Rate |
$1,583.86 |
| Rate for Payer: Aetna Commercial |
$1,425.47
|
| Rate for Payer: Aetna Medicare |
$586.03
|
| Rate for Payer: ASR ASR |
$1,536.34
|
| Rate for Payer: BCBS Complete |
$633.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,305.89
|
| Rate for Payer: BCN Commercial |
$1,305.89
|
| Rate for Payer: Cash Price |
$1,267.09
|
| Rate for Payer: Cofinity Commercial |
$1,488.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,267.09
|
| Rate for Payer: Healthscope Commercial |
$1,536.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,583.86
|
| Rate for Payer: Mclaren Commercial |
$1,425.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,267.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,346.28
|
| Rate for Payer: Nomi Health Commercial |
$1,298.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,187.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,387.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,110.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,393.80
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,259.18
|
|
|
Service Code
|
NDC 70710115903
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$465.90 |
| Max. Negotiated Rate |
$1,259.18 |
| Rate for Payer: Aetna Commercial |
$1,133.27
|
| Rate for Payer: Aetna Medicare |
$465.90
|
| Rate for Payer: ASR ASR |
$1,221.41
|
| Rate for Payer: BCBS Complete |
$503.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,038.20
|
| Rate for Payer: BCN Commercial |
$1,038.20
|
| Rate for Payer: Cash Price |
$1,007.35
|
| Rate for Payer: Cofinity Commercial |
$1,183.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.35
|
| Rate for Payer: Healthscope Commercial |
$1,221.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,259.18
|
| Rate for Payer: Mclaren Commercial |
$1,133.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,007.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.31
|
| Rate for Payer: Nomi Health Commercial |
$1,032.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$944.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,103.30
|
| Rate for Payer: Priority Health Narrow Network |
$882.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,108.08
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,259.18
|
|
|
Service Code
|
NDC 70710115903
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$944.39 |
| Max. Negotiated Rate |
$1,259.18 |
| Rate for Payer: Aetna Commercial |
$1,133.27
|
| Rate for Payer: ASR ASR |
$1,221.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,034.04
|
| Rate for Payer: BCN Commercial |
$1,034.04
|
| Rate for Payer: Cash Price |
$1,007.35
|
| Rate for Payer: Cofinity Commercial |
$1,183.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.35
|
| Rate for Payer: Healthscope Commercial |
$1,221.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,259.18
|
| Rate for Payer: Mclaren Commercial |
$1,133.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.31
|
| Rate for Payer: Nomi Health Commercial |
$1,032.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$944.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,108.08
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$364.25
|
|
|
Service Code
|
NDC 904651961
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.19 |
| Max. Negotiated Rate |
$364.25 |
| Rate for Payer: Aetna Commercial |
$327.82
|
| Rate for Payer: ASR ASR |
$353.32
|
| Rate for Payer: BCBS Trust/PPO |
$299.12
|
| Rate for Payer: BCN Commercial |
$299.12
|
| Rate for Payer: Cash Price |
$291.40
|
| Rate for Payer: Cofinity Commercial |
$342.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.40
|
| Rate for Payer: Healthscope Commercial |
$353.32
|
| Rate for Payer: Healthscope Whirlpool |
$364.25
|
| Rate for Payer: Mclaren Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.61
|
| Rate for Payer: Nomi Health Commercial |
$298.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.54
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$4.02
|
|
|
Service Code
|
NDC 51079008601
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Aetna Medicare |
$1.49
|
| Rate for Payer: ASR ASR |
$3.90
|
| Rate for Payer: BCBS Complete |
$1.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.31
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.22
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Healthscope Whirlpool |
$4.02
|
| Rate for Payer: Mclaren Commercial |
$3.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.42
|
| Rate for Payer: Nomi Health Commercial |
$3.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.52
|
| Rate for Payer: Priority Health Narrow Network |
$2.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.54
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$364.25
|
|
|
Service Code
|
NDC 904651961
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.77 |
| Max. Negotiated Rate |
$364.25 |
| Rate for Payer: Aetna Commercial |
$327.82
|
| Rate for Payer: Aetna Medicare |
$134.77
|
| Rate for Payer: ASR ASR |
$353.32
|
| Rate for Payer: BCBS Complete |
$145.70
|
| Rate for Payer: BCBS Trust/PPO |
$300.32
|
| Rate for Payer: BCN Commercial |
$300.32
|
| Rate for Payer: Cash Price |
$291.40
|
| Rate for Payer: Cofinity Commercial |
$342.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.40
|
| Rate for Payer: Healthscope Commercial |
$353.32
|
| Rate for Payer: Healthscope Whirlpool |
$364.25
|
| Rate for Payer: Mclaren Commercial |
$327.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.61
|
| Rate for Payer: Nomi Health Commercial |
$298.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$319.16
|
| Rate for Payer: Priority Health Narrow Network |
$255.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.54
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$4.02
|
|
|
Service Code
|
NDC 51079008601
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: ASR ASR |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.30
|
| Rate for Payer: BCN Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.22
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Healthscope Whirlpool |
$4.02
|
| Rate for Payer: Mclaren Commercial |
$3.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.42
|
| Rate for Payer: Nomi Health Commercial |
$3.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.54
|
|
|
MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC
|
Facility
|
IP
|
$18,349.54
|
|
|
Service Code
|
MSDRG 640
|
| Min. Negotiated Rate |
$10,803.82 |
| Max. Negotiated Rate |
$18,349.54 |
| Rate for Payer: Aetna Medicare |
$11,372.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,215.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,215.55
|
| Rate for Payer: BCBS MAPPO |
$11,372.44
|
| Rate for Payer: BCN Medicare Advantage |
$11,372.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,372.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,372.44
|
| Rate for Payer: Mclaren Medicare |
$11,372.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,941.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,078.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,509.68
|
| Rate for Payer: PACE Medicare |
$10,803.82
|
| Rate for Payer: PACE SWMI |
$11,372.44
|
| Rate for Payer: PHP Commercial |
$12,509.68
|
| Rate for Payer: PHP Medicare Advantage |
$11,372.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18,349.54
|
| Rate for Payer: Priority Health Medicare |
$11,372.44
|
| Rate for Payer: Priority Health Narrow Network |
$14,679.63
|
| Rate for Payer: Railroad Medicare Medicare |
$11,372.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,372.44
|
| Rate for Payer: UHC Exchange |
$17,627.28
|
| Rate for Payer: UHCCP DNSP |
$11,372.44
|
| Rate for Payer: VA VA |
$11,372.44
|
|
|
MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC
|
Facility
|
IP
|
$11,405.63
|
|
|
Service Code
|
MSDRG 641
|
| Min. Negotiated Rate |
$6,990.55 |
| Max. Negotiated Rate |
$11,405.63 |
| Rate for Payer: Aetna Medicare |
$7,358.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,198.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,198.09
|
| Rate for Payer: BCBS MAPPO |
$7,358.47
|
| Rate for Payer: BCN Medicare Advantage |
$7,358.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,358.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,358.47
|
| Rate for Payer: Mclaren Medicare |
$7,358.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,726.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,462.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,094.32
|
| Rate for Payer: PACE Medicare |
$6,990.55
|
| Rate for Payer: PACE SWMI |
$7,358.47
|
| Rate for Payer: PHP Commercial |
$8,094.32
|
| Rate for Payer: PHP Medicare Advantage |
$7,358.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,691.53
|
| Rate for Payer: Priority Health Medicare |
$7,358.47
|
| Rate for Payer: Priority Health Narrow Network |
$8,553.23
|
| Rate for Payer: Railroad Medicare Medicare |
$7,358.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,358.47
|
| Rate for Payer: UHC Exchange |
$11,405.63
|
| Rate for Payer: UHCCP DNSP |
$7,358.47
|
| Rate for Payer: VA VA |
$7,358.47
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$431.04
|
|
|
Service Code
|
NDC 59762500802
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$323.28 |
| Max. Negotiated Rate |
$431.04 |
| Rate for Payer: Aetna Commercial |
$387.94
|
| Rate for Payer: ASR ASR |
$418.11
|
| Rate for Payer: BCBS Trust/PPO |
$353.97
|
| Rate for Payer: BCN Commercial |
$353.97
|
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Cofinity Commercial |
$405.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.83
|
| Rate for Payer: Healthscope Commercial |
$418.11
|
| Rate for Payer: Healthscope Whirlpool |
$431.04
|
| Rate for Payer: Mclaren Commercial |
$387.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.38
|
| Rate for Payer: Nomi Health Commercial |
$353.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$379.32
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$431.04
|
|
|
Service Code
|
NDC 59762500802
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.48 |
| Max. Negotiated Rate |
$431.04 |
| Rate for Payer: Aetna Commercial |
$387.94
|
| Rate for Payer: Aetna Medicare |
$159.48
|
| Rate for Payer: ASR ASR |
$418.11
|
| Rate for Payer: BCBS Complete |
$172.42
|
| Rate for Payer: BCBS Trust/PPO |
$355.39
|
| Rate for Payer: BCN Commercial |
$355.39
|
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Cofinity Commercial |
$405.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.83
|
| Rate for Payer: Healthscope Commercial |
$418.11
|
| Rate for Payer: Healthscope Whirlpool |
$431.04
|
| Rate for Payer: Mclaren Commercial |
$387.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$344.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.38
|
| Rate for Payer: Nomi Health Commercial |
$353.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$377.68
|
| Rate for Payer: Priority Health Narrow Network |
$302.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$379.32
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$258.62
|
|
|
Service Code
|
NDC 43386016106
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.69 |
| Max. Negotiated Rate |
$258.62 |
| Rate for Payer: Aetna Commercial |
$232.76
|
| Rate for Payer: Aetna Medicare |
$95.69
|
| Rate for Payer: ASR ASR |
$250.87
|
| Rate for Payer: BCBS Complete |
$103.45
|
| Rate for Payer: BCBS Trust/PPO |
$213.24
|
| Rate for Payer: BCN Commercial |
$213.24
|
| Rate for Payer: Cash Price |
$206.90
|
| Rate for Payer: Cofinity Commercial |
$243.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.90
|
| Rate for Payer: Healthscope Commercial |
$250.87
|
| Rate for Payer: Healthscope Whirlpool |
$258.62
|
| Rate for Payer: Mclaren Commercial |
$232.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.83
|
| Rate for Payer: Nomi Health Commercial |
$212.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$226.61
|
| Rate for Payer: Priority Health Narrow Network |
$181.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.59
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$216.29
|
|
|
Service Code
|
NDC 70954044410
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.03 |
| Max. Negotiated Rate |
$216.29 |
| Rate for Payer: Aetna Commercial |
$194.66
|
| Rate for Payer: Aetna Medicare |
$80.03
|
| Rate for Payer: ASR ASR |
$209.80
|
| Rate for Payer: BCBS Complete |
$86.52
|
| Rate for Payer: BCBS Trust/PPO |
$178.33
|
| Rate for Payer: BCN Commercial |
$178.33
|
| Rate for Payer: Cash Price |
$173.03
|
| Rate for Payer: Cofinity Commercial |
$203.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.03
|
| Rate for Payer: Healthscope Commercial |
$209.80
|
| Rate for Payer: Healthscope Whirlpool |
$216.29
|
| Rate for Payer: Mclaren Commercial |
$194.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.84
|
| Rate for Payer: Nomi Health Commercial |
$177.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$189.51
|
| Rate for Payer: Priority Health Narrow Network |
$151.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.33
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$216.29
|
|
|
Service Code
|
NDC 70954044410
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.22 |
| Max. Negotiated Rate |
$216.29 |
| Rate for Payer: Aetna Commercial |
$194.66
|
| Rate for Payer: ASR ASR |
$209.80
|
| Rate for Payer: BCBS Trust/PPO |
$177.62
|
| Rate for Payer: BCN Commercial |
$177.62
|
| Rate for Payer: Cash Price |
$173.03
|
| Rate for Payer: Cofinity Commercial |
$203.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.03
|
| Rate for Payer: Healthscope Commercial |
$209.80
|
| Rate for Payer: Healthscope Whirlpool |
$216.29
|
| Rate for Payer: Mclaren Commercial |
$194.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.84
|
| Rate for Payer: Nomi Health Commercial |
$177.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.33
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$258.62
|
|
|
Service Code
|
NDC 59762500801
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.69 |
| Max. Negotiated Rate |
$258.62 |
| Rate for Payer: Aetna Commercial |
$232.76
|
| Rate for Payer: Aetna Medicare |
$95.69
|
| Rate for Payer: ASR ASR |
$250.87
|
| Rate for Payer: BCBS Complete |
$103.45
|
| Rate for Payer: BCBS Trust/PPO |
$213.24
|
| Rate for Payer: BCN Commercial |
$213.24
|
| Rate for Payer: Cash Price |
$206.90
|
| Rate for Payer: Cofinity Commercial |
$243.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.90
|
| Rate for Payer: Healthscope Commercial |
$250.87
|
| Rate for Payer: Healthscope Whirlpool |
$258.62
|
| Rate for Payer: Mclaren Commercial |
$232.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.83
|
| Rate for Payer: Nomi Health Commercial |
$212.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$226.61
|
| Rate for Payer: Priority Health Narrow Network |
$181.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.59
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$258.62
|
|
|
Service Code
|
NDC 43386016106
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.97 |
| Max. Negotiated Rate |
$258.62 |
| Rate for Payer: Aetna Commercial |
$232.76
|
| Rate for Payer: ASR ASR |
$250.87
|
| Rate for Payer: BCBS Trust/PPO |
$212.38
|
| Rate for Payer: BCN Commercial |
$212.38
|
| Rate for Payer: Cash Price |
$206.90
|
| Rate for Payer: Cofinity Commercial |
$243.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.90
|
| Rate for Payer: Healthscope Commercial |
$250.87
|
| Rate for Payer: Healthscope Whirlpool |
$258.62
|
| Rate for Payer: Mclaren Commercial |
$232.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.83
|
| Rate for Payer: Nomi Health Commercial |
$212.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.59
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$258.62
|
|
|
Service Code
|
NDC 59762500801
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.97 |
| Max. Negotiated Rate |
$258.62 |
| Rate for Payer: Aetna Commercial |
$232.76
|
| Rate for Payer: ASR ASR |
$250.87
|
| Rate for Payer: BCBS Trust/PPO |
$212.38
|
| Rate for Payer: BCN Commercial |
$212.38
|
| Rate for Payer: Cash Price |
$206.90
|
| Rate for Payer: Cofinity Commercial |
$243.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.90
|
| Rate for Payer: Healthscope Commercial |
$250.87
|
| Rate for Payer: Healthscope Whirlpool |
$258.62
|
| Rate for Payer: Mclaren Commercial |
$232.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.83
|
| Rate for Payer: Nomi Health Commercial |
$212.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.59
|
|
