|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$813.40
|
|
|
Service Code
|
NDC 904655861
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$610.05 |
| Max. Negotiated Rate |
$813.40 |
| Rate for Payer: Aetna Commercial |
$732.06
|
| Rate for Payer: ASR ASR |
$789.00
|
| Rate for Payer: BCBS Trust/PPO |
$667.96
|
| Rate for Payer: BCN Commercial |
$667.96
|
| Rate for Payer: Cash Price |
$650.72
|
| Rate for Payer: Cofinity Commercial |
$764.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$650.72
|
| Rate for Payer: Healthscope Commercial |
$789.00
|
| Rate for Payer: Healthscope Whirlpool |
$813.40
|
| Rate for Payer: Mclaren Commercial |
$732.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$691.39
|
| Rate for Payer: Nomi Health Commercial |
$666.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$610.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$715.79
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$8.95
|
|
|
Service Code
|
NDC 406833023
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$8.95 |
| Rate for Payer: Aetna Commercial |
$8.06
|
| Rate for Payer: Aetna Medicare |
$3.31
|
| Rate for Payer: ASR ASR |
$8.68
|
| Rate for Payer: BCBS Complete |
$3.58
|
| Rate for Payer: BCBS Trust/PPO |
$7.38
|
| Rate for Payer: BCN Commercial |
$7.38
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Cofinity Commercial |
$8.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.16
|
| Rate for Payer: Healthscope Commercial |
$8.68
|
| Rate for Payer: Healthscope Whirlpool |
$8.95
|
| Rate for Payer: Mclaren Commercial |
$8.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.61
|
| Rate for Payer: Nomi Health Commercial |
$7.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.84
|
| Rate for Payer: Priority Health Narrow Network |
$6.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.88
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$895.30
|
|
|
Service Code
|
NDC 406833062
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$331.26 |
| Max. Negotiated Rate |
$895.30 |
| Rate for Payer: Aetna Commercial |
$805.77
|
| Rate for Payer: Aetna Medicare |
$331.26
|
| Rate for Payer: ASR ASR |
$868.44
|
| Rate for Payer: BCBS Complete |
$358.12
|
| Rate for Payer: BCBS Trust/PPO |
$738.17
|
| Rate for Payer: BCN Commercial |
$738.17
|
| Rate for Payer: Cash Price |
$716.24
|
| Rate for Payer: Cofinity Commercial |
$841.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.24
|
| Rate for Payer: Healthscope Commercial |
$868.44
|
| Rate for Payer: Healthscope Whirlpool |
$895.30
|
| Rate for Payer: Mclaren Commercial |
$805.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$716.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$761.00
|
| Rate for Payer: Nomi Health Commercial |
$734.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$784.46
|
| Rate for Payer: Priority Health Narrow Network |
$627.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$787.86
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$895.30
|
|
|
Service Code
|
NDC 406833062
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$671.48 |
| Max. Negotiated Rate |
$895.30 |
| Rate for Payer: Aetna Commercial |
$805.77
|
| Rate for Payer: ASR ASR |
$868.44
|
| Rate for Payer: BCBS Trust/PPO |
$735.22
|
| Rate for Payer: BCN Commercial |
$735.22
|
| Rate for Payer: Cash Price |
$716.24
|
| Rate for Payer: Cofinity Commercial |
$841.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.24
|
| Rate for Payer: Healthscope Commercial |
$868.44
|
| Rate for Payer: Healthscope Whirlpool |
$895.30
|
| Rate for Payer: Mclaren Commercial |
$805.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$761.00
|
| Rate for Payer: Nomi Health Commercial |
$734.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$787.86
|
|
|
MORPHINE INHALATION (VARIABLE DOSE)
|
Facility
|
IP
|
$11.62
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
300139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Aetna Commercial |
$10.46
|
| Rate for Payer: ASR ASR |
$11.27
|
| Rate for Payer: BCBS Trust/PPO |
$9.54
|
| Rate for Payer: BCN Commercial |
$9.54
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cofinity Commercial |
$10.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$11.27
|
| Rate for Payer: Healthscope Whirlpool |
$11.62
|
| Rate for Payer: Mclaren Commercial |
$10.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.88
|
| Rate for Payer: Nomi Health Commercial |
$9.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.23
|
|
|
MORPHINE INHALATION (VARIABLE DOSE)
|
Facility
|
OP
|
$11.62
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
300139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Aetna Commercial |
$10.46
|
| Rate for Payer: Aetna Medicare |
$4.30
|
| Rate for Payer: ASR ASR |
$11.27
|
| Rate for Payer: BCBS Complete |
$4.65
|
| Rate for Payer: BCBS Trust/PPO |
$9.58
|
| Rate for Payer: BCN Commercial |
$9.58
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cofinity Commercial |
$10.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$11.27
|
| Rate for Payer: Healthscope Whirlpool |
$11.62
|
| Rate for Payer: Mclaren Commercial |
$10.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.88
|
| Rate for Payer: Nomi Health Commercial |
$9.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.15
|
| Rate for Payer: Priority Health Narrow Network |
$2.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.23
|
|
|
MORPHINE (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$134.55
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
15852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.91 |
| Max. Negotiated Rate |
$134.55 |
| Rate for Payer: Aetna Commercial |
$121.09
|
| Rate for Payer: Aetna Commercial |
$191.52
|
| Rate for Payer: ASR ASR |
$206.42
|
| Rate for Payer: ASR ASR |
$130.51
|
| Rate for Payer: BCBS Trust/PPO |
$174.75
|
| Rate for Payer: BCBS Trust/PPO |
$110.49
|
| Rate for Payer: BCN Commercial |
$174.75
|
| Rate for Payer: BCN Commercial |
$110.49
|
| Rate for Payer: Cash Price |
$170.24
|
| Rate for Payer: Cash Price |
$107.64
|
| Rate for Payer: Cofinity Commercial |
$126.48
|
| Rate for Payer: Cofinity Commercial |
$200.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.64
|
| Rate for Payer: Healthscope Commercial |
$130.51
|
| Rate for Payer: Healthscope Commercial |
$206.42
|
| Rate for Payer: Healthscope Whirlpool |
$212.80
|
| Rate for Payer: Healthscope Whirlpool |
$134.55
|
| Rate for Payer: Mclaren Commercial |
$191.52
|
| Rate for Payer: Mclaren Commercial |
$121.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.37
|
| Rate for Payer: Nomi Health Commercial |
$174.50
|
| Rate for Payer: Nomi Health Commercial |
$110.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.26
|
|
|
MORPHINE (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$212.80
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
15852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$212.80 |
| Rate for Payer: Aetna Commercial |
$191.52
|
| Rate for Payer: Aetna Commercial |
$121.09
|
| Rate for Payer: Aetna Medicare |
$49.78
|
| Rate for Payer: Aetna Medicare |
$78.74
|
| Rate for Payer: ASR ASR |
$206.42
|
| Rate for Payer: ASR ASR |
$130.51
|
| Rate for Payer: BCBS Complete |
$53.82
|
| Rate for Payer: BCBS Complete |
$85.12
|
| Rate for Payer: BCBS Trust/PPO |
$175.45
|
| Rate for Payer: BCBS Trust/PPO |
$110.94
|
| Rate for Payer: BCN Commercial |
$110.94
|
| Rate for Payer: BCN Commercial |
$175.45
|
| Rate for Payer: Cash Price |
$170.24
|
| Rate for Payer: Cash Price |
$107.64
|
| Rate for Payer: Cash Price |
$170.24
|
| Rate for Payer: Cash Price |
$107.64
|
| Rate for Payer: Cofinity Commercial |
$126.48
|
| Rate for Payer: Cofinity Commercial |
$200.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.64
|
| Rate for Payer: Healthscope Commercial |
$206.42
|
| Rate for Payer: Healthscope Commercial |
$130.51
|
| Rate for Payer: Healthscope Whirlpool |
$212.80
|
| Rate for Payer: Healthscope Whirlpool |
$134.55
|
| Rate for Payer: Mclaren Commercial |
$191.52
|
| Rate for Payer: Mclaren Commercial |
$121.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$170.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.88
|
| Rate for Payer: Nomi Health Commercial |
$110.33
|
| Rate for Payer: Nomi Health Commercial |
$174.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14.00
|
| Rate for Payer: Priority Health Narrow Network |
$11.20
|
| Rate for Payer: Priority Health Narrow Network |
$11.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.26
|
|
|
MORPHINE VARIABLE DOSE
|
Facility
|
OP
|
$11.62
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
150710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Aetna Commercial |
$10.46
|
| Rate for Payer: Aetna Medicare |
$4.30
|
| Rate for Payer: ASR ASR |
$11.27
|
| Rate for Payer: BCBS Complete |
$4.65
|
| Rate for Payer: BCBS Trust/PPO |
$9.58
|
| Rate for Payer: BCN Commercial |
$9.58
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cofinity Commercial |
$10.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$11.27
|
| Rate for Payer: Healthscope Whirlpool |
$11.62
|
| Rate for Payer: Mclaren Commercial |
$10.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.88
|
| Rate for Payer: Nomi Health Commercial |
$9.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.15
|
| Rate for Payer: Priority Health Narrow Network |
$2.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.23
|
|
|
MORPHINE VARIABLE DOSE
|
Facility
|
IP
|
$11.62
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
150710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Aetna Commercial |
$10.46
|
| Rate for Payer: ASR ASR |
$11.27
|
| Rate for Payer: BCBS Trust/PPO |
$9.54
|
| Rate for Payer: BCN Commercial |
$9.54
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cofinity Commercial |
$10.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$11.27
|
| Rate for Payer: Healthscope Whirlpool |
$11.62
|
| Rate for Payer: Mclaren Commercial |
$10.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.88
|
| Rate for Payer: Nomi Health Commercial |
$9.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.23
|
|
|
MOUTH PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$20,514.78
|
|
|
Service Code
|
MSDRG 137
|
| Min. Negotiated Rate |
$11,881.99 |
| Max. Negotiated Rate |
$20,514.78 |
| Rate for Payer: Aetna Medicare |
$12,507.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,634.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,634.20
|
| Rate for Payer: BCBS MAPPO |
$12,507.36
|
| Rate for Payer: BCN Medicare Advantage |
$12,507.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,507.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,507.36
|
| Rate for Payer: Mclaren Medicare |
$12,507.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,132.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,383.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,758.10
|
| Rate for Payer: PACE Medicare |
$11,881.99
|
| Rate for Payer: PACE SWMI |
$12,507.36
|
| Rate for Payer: PHP Commercial |
$13,758.10
|
| Rate for Payer: PHP Medicare Advantage |
$12,507.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20,514.78
|
| Rate for Payer: Priority Health Medicare |
$12,507.36
|
| Rate for Payer: Priority Health Narrow Network |
$16,411.82
|
| Rate for Payer: Railroad Medicare Medicare |
$12,507.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,507.36
|
| Rate for Payer: UHC Exchange |
$19,386.41
|
| Rate for Payer: UHCCP DNSP |
$12,507.36
|
| Rate for Payer: VA VA |
$12,507.36
|
|
|
MOUTH PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$12,611.11
|
|
|
Service Code
|
MSDRG 138
|
| Min. Negotiated Rate |
$7,729.39 |
| Max. Negotiated Rate |
$12,611.11 |
| Rate for Payer: Aetna Medicare |
$8,136.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,170.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,170.25
|
| Rate for Payer: BCBS MAPPO |
$8,136.20
|
| Rate for Payer: BCN Medicare Advantage |
$8,136.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,136.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,136.20
|
| Rate for Payer: Mclaren Medicare |
$8,136.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,543.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,356.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,949.82
|
| Rate for Payer: PACE Medicare |
$7,729.39
|
| Rate for Payer: PACE SWMI |
$8,136.20
|
| Rate for Payer: PHP Commercial |
$8,949.82
|
| Rate for Payer: PHP Medicare Advantage |
$8,136.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12,175.32
|
| Rate for Payer: Priority Health Medicare |
$8,136.20
|
| Rate for Payer: Priority Health Narrow Network |
$9,740.26
|
| Rate for Payer: Railroad Medicare Medicare |
$8,136.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,136.20
|
| Rate for Payer: UHC Exchange |
$12,611.11
|
| Rate for Payer: UHCCP DNSP |
$8,136.20
|
| Rate for Payer: VA VA |
$8,136.20
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$108.96
|
|
|
Service Code
|
NDC 65862084003
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.31 |
| Max. Negotiated Rate |
$108.96 |
| Rate for Payer: Aetna Commercial |
$98.06
|
| Rate for Payer: Aetna Medicare |
$40.31
|
| Rate for Payer: ASR ASR |
$105.69
|
| Rate for Payer: BCBS Complete |
$43.58
|
| Rate for Payer: BCBS Trust/PPO |
$89.84
|
| Rate for Payer: BCN Commercial |
$89.84
|
| Rate for Payer: Cash Price |
$87.17
|
| Rate for Payer: Cofinity Commercial |
$102.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.17
|
| Rate for Payer: Healthscope Commercial |
$105.69
|
| Rate for Payer: Healthscope Whirlpool |
$108.96
|
| Rate for Payer: Mclaren Commercial |
$98.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.62
|
| Rate for Payer: Nomi Health Commercial |
$89.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$95.47
|
| Rate for Payer: Priority Health Narrow Network |
$76.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.88
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$217.88
|
|
|
Service Code
|
NDC 60505058204
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.41 |
| Max. Negotiated Rate |
$217.88 |
| Rate for Payer: Aetna Commercial |
$196.09
|
| Rate for Payer: ASR ASR |
$211.34
|
| Rate for Payer: BCBS Trust/PPO |
$178.92
|
| Rate for Payer: BCN Commercial |
$178.92
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cofinity Commercial |
$204.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.30
|
| Rate for Payer: Healthscope Commercial |
$211.34
|
| Rate for Payer: Healthscope Whirlpool |
$217.88
|
| Rate for Payer: Mclaren Commercial |
$196.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.19
|
| Rate for Payer: Nomi Health Commercial |
$178.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.73
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$93.77
|
|
|
Service Code
|
NDC 781713593
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.69 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$84.39
|
| Rate for Payer: Aetna Medicare |
$34.69
|
| Rate for Payer: ASR ASR |
$90.95
|
| Rate for Payer: BCBS Complete |
$37.51
|
| Rate for Payer: BCBS Trust/PPO |
$77.31
|
| Rate for Payer: BCN Commercial |
$77.31
|
| Rate for Payer: Cash Price |
$75.01
|
| Rate for Payer: Cofinity Commercial |
$88.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.01
|
| Rate for Payer: Healthscope Commercial |
$90.95
|
| Rate for Payer: Healthscope Whirlpool |
$93.77
|
| Rate for Payer: Mclaren Commercial |
$84.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.70
|
| Rate for Payer: Nomi Health Commercial |
$76.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$82.16
|
| Rate for Payer: Priority Health Narrow Network |
$65.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.51
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$108.96
|
|
|
Service Code
|
NDC 65862084003
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.72 |
| Max. Negotiated Rate |
$108.96 |
| Rate for Payer: Aetna Commercial |
$98.06
|
| Rate for Payer: ASR ASR |
$105.69
|
| Rate for Payer: BCBS Trust/PPO |
$89.48
|
| Rate for Payer: BCN Commercial |
$89.48
|
| Rate for Payer: Cash Price |
$87.17
|
| Rate for Payer: Cofinity Commercial |
$102.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.17
|
| Rate for Payer: Healthscope Commercial |
$105.69
|
| Rate for Payer: Healthscope Whirlpool |
$108.96
|
| Rate for Payer: Mclaren Commercial |
$98.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.62
|
| Rate for Payer: Nomi Health Commercial |
$89.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.88
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$217.88
|
|
|
Service Code
|
NDC 60505058204
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.61 |
| Max. Negotiated Rate |
$217.88 |
| Rate for Payer: Aetna Commercial |
$196.09
|
| Rate for Payer: Aetna Medicare |
$80.61
|
| Rate for Payer: ASR ASR |
$211.34
|
| Rate for Payer: BCBS Complete |
$87.15
|
| Rate for Payer: BCBS Trust/PPO |
$179.64
|
| Rate for Payer: BCN Commercial |
$179.64
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cofinity Commercial |
$204.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.30
|
| Rate for Payer: Healthscope Commercial |
$211.34
|
| Rate for Payer: Healthscope Whirlpool |
$217.88
|
| Rate for Payer: Mclaren Commercial |
$196.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.19
|
| Rate for Payer: Nomi Health Commercial |
$178.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$190.90
|
| Rate for Payer: Priority Health Narrow Network |
$152.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.73
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$38.99
|
|
|
Service Code
|
NDC 68180042201
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$38.99 |
| Rate for Payer: Aetna Commercial |
$35.09
|
| Rate for Payer: Aetna Medicare |
$14.43
|
| Rate for Payer: ASR ASR |
$37.82
|
| Rate for Payer: BCBS Complete |
$15.59
|
| Rate for Payer: BCBS Trust/PPO |
$32.14
|
| Rate for Payer: BCN Commercial |
$32.14
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Cofinity Commercial |
$36.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.19
|
| Rate for Payer: Healthscope Commercial |
$37.82
|
| Rate for Payer: Healthscope Whirlpool |
$38.99
|
| Rate for Payer: Mclaren Commercial |
$35.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.14
|
| Rate for Payer: Nomi Health Commercial |
$31.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34.16
|
| Rate for Payer: Priority Health Narrow Network |
$27.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.31
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$38.99
|
|
|
Service Code
|
NDC 68180042201
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$38.99 |
| Rate for Payer: Aetna Commercial |
$35.09
|
| Rate for Payer: ASR ASR |
$37.82
|
| Rate for Payer: BCBS Trust/PPO |
$32.02
|
| Rate for Payer: BCN Commercial |
$32.02
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Cofinity Commercial |
$36.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.19
|
| Rate for Payer: Healthscope Commercial |
$37.82
|
| Rate for Payer: Healthscope Whirlpool |
$38.99
|
| Rate for Payer: Mclaren Commercial |
$35.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.14
|
| Rate for Payer: Nomi Health Commercial |
$31.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.31
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$93.77
|
|
|
Service Code
|
NDC 781713593
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.32 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$84.39
|
| Rate for Payer: ASR ASR |
$90.95
|
| Rate for Payer: BCBS Trust/PPO |
$77.00
|
| Rate for Payer: BCN Commercial |
$77.00
|
| Rate for Payer: Cash Price |
$75.01
|
| Rate for Payer: Cofinity Commercial |
$88.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.01
|
| Rate for Payer: Healthscope Commercial |
$90.95
|
| Rate for Payer: Healthscope Whirlpool |
$93.77
|
| Rate for Payer: Mclaren Commercial |
$84.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.70
|
| Rate for Payer: Nomi Health Commercial |
$76.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.51
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$29,180.98
|
|
|
Service Code
|
APR-DRG 2993
|
| Min. Negotiated Rate |
$26,383.10 |
| Max. Negotiated Rate |
$29,180.98 |
| Rate for Payer: BCBS Complete |
$29,180.98
|
| Rate for Payer: Mclaren Medicaid |
$27,791.41
|
| Rate for Payer: Meridian Medicaid |
$29,180.98
|
| Rate for Payer: PHP Medicaid |
$26,383.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$27,791.41
|
| Rate for Payer: UHC Medicaid |
$27,791.41
|
| Rate for Payer: UHCCP Medicaid |
$27,791.41
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$38,428.78
|
|
|
Service Code
|
APR-DRG 2994
|
| Min. Negotiated Rate |
$34,744.22 |
| Max. Negotiated Rate |
$38,428.78 |
| Rate for Payer: BCBS Complete |
$38,428.78
|
| Rate for Payer: Mclaren Medicaid |
$36,598.84
|
| Rate for Payer: Meridian Medicaid |
$38,428.78
|
| Rate for Payer: PHP Medicaid |
$34,744.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$36,598.84
|
| Rate for Payer: UHC Medicaid |
$36,598.84
|
| Rate for Payer: UHCCP Medicaid |
$36,598.84
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$21,142.43
|
|
|
Service Code
|
APR-DRG 2992
|
| Min. Negotiated Rate |
$19,115.28 |
| Max. Negotiated Rate |
$21,142.43 |
| Rate for Payer: BCBS Complete |
$21,142.43
|
| Rate for Payer: Mclaren Medicaid |
$20,135.64
|
| Rate for Payer: Meridian Medicaid |
$21,142.43
|
| Rate for Payer: PHP Medicaid |
$19,115.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,135.64
|
| Rate for Payer: UHC Medicaid |
$20,135.64
|
| Rate for Payer: UHCCP Medicaid |
$20,135.64
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$17,511.42
|
|
|
Service Code
|
APR-DRG 2991
|
| Min. Negotiated Rate |
$15,832.42 |
| Max. Negotiated Rate |
$17,511.42 |
| Rate for Payer: BCBS Complete |
$17,511.42
|
| Rate for Payer: Mclaren Medicaid |
$16,677.55
|
| Rate for Payer: Meridian Medicaid |
$17,511.42
|
| Rate for Payer: PHP Medicaid |
$15,832.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,677.55
|
| Rate for Payer: UHC Medicaid |
$16,677.55
|
| Rate for Payer: UHCCP Medicaid |
$16,677.55
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC
|
Facility
|
IP
|
$99,174.90
|
|
|
Service Code
|
MSDRG 427
|
| Min. Negotiated Rate |
$51,050.48 |
| Max. Negotiated Rate |
$99,174.90 |
| Rate for Payer: Aetna Medicare |
$53,737.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67,171.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67,171.69
|
| Rate for Payer: BCBS MAPPO |
$53,737.35
|
| Rate for Payer: BCN Medicare Advantage |
$53,737.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53,737.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$53,737.35
|
| Rate for Payer: Mclaren Medicare |
$53,737.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56,424.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61,797.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$59,111.08
|
| Rate for Payer: PACE Medicare |
$51,050.48
|
| Rate for Payer: PACE SWMI |
$53,737.35
|
| Rate for Payer: PHP Commercial |
$59,111.08
|
| Rate for Payer: PHP Medicare Advantage |
$53,737.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$99,174.90
|
| Rate for Payer: Priority Health Medicare |
$53,737.35
|
| Rate for Payer: Priority Health Narrow Network |
$79,339.92
|
| Rate for Payer: Railroad Medicare Medicare |
$53,737.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$53,737.35
|
| Rate for Payer: UHC Exchange |
$83,292.89
|
| Rate for Payer: UHCCP DNSP |
$53,737.35
|
| Rate for Payer: VA VA |
$53,737.35
|
|
