|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$151,418.06
|
|
|
Service Code
|
MSDRG 426
|
| Min. Negotiated Rate |
$77,064.76 |
| Max. Negotiated Rate |
$151,418.06 |
| Rate for Payer: Aetna Medicare |
$81,120.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101,401.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101,401.00
|
| Rate for Payer: BCBS MAPPO |
$81,120.80
|
| Rate for Payer: BCN Medicare Advantage |
$81,120.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81,120.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$81,120.80
|
| Rate for Payer: Mclaren Medicare |
$81,120.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85,176.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93,288.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$89,232.88
|
| Rate for Payer: PACE Medicare |
$77,064.76
|
| Rate for Payer: PACE SWMI |
$81,120.80
|
| Rate for Payer: PHP Commercial |
$89,232.88
|
| Rate for Payer: PHP Medicare Advantage |
$81,120.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$151,418.06
|
| Rate for Payer: Priority Health Medicare |
$81,120.80
|
| Rate for Payer: Priority Health Narrow Network |
$121,134.45
|
| Rate for Payer: Railroad Medicare Medicare |
$81,120.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$81,120.80
|
| Rate for Payer: UHC Exchange |
$125,737.24
|
| Rate for Payer: UHCCP DNSP |
$81,120.80
|
| Rate for Payer: VA VA |
$81,120.80
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC
|
Facility
|
IP
|
$77,239.53
|
|
|
Service Code
|
MSDRG 428
|
| Min. Negotiated Rate |
$40,127.86 |
| Max. Negotiated Rate |
$77,239.53 |
| Rate for Payer: Aetna Medicare |
$42,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52,799.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52,799.81
|
| Rate for Payer: BCBS MAPPO |
$42,239.85
|
| Rate for Payer: BCN Medicare Advantage |
$42,239.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42,239.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$42,239.85
|
| Rate for Payer: Mclaren Medicare |
$42,239.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44,351.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48,575.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$46,463.83
|
| Rate for Payer: PACE Medicare |
$40,127.86
|
| Rate for Payer: PACE SWMI |
$42,239.85
|
| Rate for Payer: PHP Commercial |
$46,463.83
|
| Rate for Payer: PHP Medicare Advantage |
$42,239.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$77,239.53
|
| Rate for Payer: Priority Health Medicare |
$42,239.85
|
| Rate for Payer: Priority Health Narrow Network |
$61,791.63
|
| Rate for Payer: Railroad Medicare Medicare |
$42,239.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42,239.85
|
| Rate for Payer: UHC Exchange |
$65,471.77
|
| Rate for Payer: UHCCP DNSP |
$42,239.85
|
| Rate for Payer: VA VA |
$42,239.85
|
|
|
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$91,797.17
|
|
|
Service Code
|
MSDRG 447
|
| Min. Negotiated Rate |
$47,376.78 |
| Max. Negotiated Rate |
$91,797.17 |
| Rate for Payer: Aetna Medicare |
$49,870.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62,337.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62,337.86
|
| Rate for Payer: BCBS MAPPO |
$49,870.29
|
| Rate for Payer: BCN Medicare Advantage |
$49,870.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49,870.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$49,870.29
|
| Rate for Payer: Mclaren Medicare |
$49,870.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52,363.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57,350.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$54,857.32
|
| Rate for Payer: PACE Medicare |
$47,376.78
|
| Rate for Payer: PACE SWMI |
$49,870.29
|
| Rate for Payer: PHP Commercial |
$54,857.32
|
| Rate for Payer: PHP Medicare Advantage |
$49,870.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$91,797.17
|
| Rate for Payer: Priority Health Medicare |
$49,870.29
|
| Rate for Payer: Priority Health Narrow Network |
$73,437.73
|
| Rate for Payer: Railroad Medicare Medicare |
$49,870.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49,870.29
|
| Rate for Payer: UHC Exchange |
$77,298.95
|
| Rate for Payer: UHCCP DNSP |
$49,870.29
|
| Rate for Payer: VA VA |
$49,870.29
|
|
|
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
|
IP
|
$58,263.50
|
|
|
Service Code
|
MSDRG 448
|
| Min. Negotiated Rate |
$30,678.82 |
| Max. Negotiated Rate |
$58,263.50 |
| Rate for Payer: Aetna Medicare |
$32,293.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40,366.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40,366.86
|
| Rate for Payer: BCBS MAPPO |
$32,293.49
|
| Rate for Payer: BCN Medicare Advantage |
$32,293.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32,293.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$32,293.49
|
| Rate for Payer: Mclaren Medicare |
$32,293.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33,908.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37,137.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$35,522.84
|
| Rate for Payer: PACE Medicare |
$30,678.82
|
| Rate for Payer: PACE SWMI |
$32,293.49
|
| Rate for Payer: PHP Commercial |
$35,522.84
|
| Rate for Payer: PHP Medicare Advantage |
$32,293.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$58,263.50
|
| Rate for Payer: Priority Health Medicare |
$32,293.49
|
| Rate for Payer: Priority Health Narrow Network |
$46,610.80
|
| Rate for Payer: Railroad Medicare Medicare |
$32,293.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32,293.49
|
| Rate for Payer: UHC Exchange |
$50,054.91
|
| Rate for Payer: UHCCP DNSP |
$32,293.49
|
| Rate for Payer: VA VA |
$32,293.49
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC
|
Facility
|
IP
|
$17,048.48
|
|
|
Service Code
|
MSDRG 059
|
| Min. Negotiated Rate |
$10,155.96 |
| Max. Negotiated Rate |
$17,048.48 |
| Rate for Payer: Aetna Medicare |
$10,690.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,363.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,363.10
|
| Rate for Payer: BCBS MAPPO |
$10,690.48
|
| Rate for Payer: BCN Medicare Advantage |
$10,690.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,690.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,690.48
|
| Rate for Payer: Mclaren Medicare |
$10,690.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,225.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,294.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,759.53
|
| Rate for Payer: PACE Medicare |
$10,155.96
|
| Rate for Payer: PACE SWMI |
$10,690.48
|
| Rate for Payer: PHP Commercial |
$11,759.53
|
| Rate for Payer: PHP Medicare Advantage |
$10,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17,048.48
|
| Rate for Payer: Priority Health Medicare |
$10,690.48
|
| Rate for Payer: Priority Health Narrow Network |
$13,638.78
|
| Rate for Payer: Railroad Medicare Medicare |
$10,690.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,690.48
|
| Rate for Payer: UHC Exchange |
$16,570.24
|
| Rate for Payer: UHCCP DNSP |
$10,690.48
|
| Rate for Payer: VA VA |
$10,690.48
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC
|
Facility
|
IP
|
$23,486.48
|
|
|
Service Code
|
MSDRG 058
|
| Min. Negotiated Rate |
$13,361.74 |
| Max. Negotiated Rate |
$23,486.48 |
| Rate for Payer: Aetna Medicare |
$14,064.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,581.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,581.24
|
| Rate for Payer: BCBS MAPPO |
$14,064.99
|
| Rate for Payer: BCN Medicare Advantage |
$14,064.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,064.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,064.99
|
| Rate for Payer: Mclaren Medicare |
$14,064.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,768.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,174.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,471.49
|
| Rate for Payer: PACE Medicare |
$13,361.74
|
| Rate for Payer: PACE SWMI |
$14,064.99
|
| Rate for Payer: PHP Commercial |
$15,471.49
|
| Rate for Payer: PHP Medicare Advantage |
$14,064.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23,486.48
|
| Rate for Payer: Priority Health Medicare |
$14,064.99
|
| Rate for Payer: Priority Health Narrow Network |
$18,789.18
|
| Rate for Payer: Railroad Medicare Medicare |
$14,064.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,064.99
|
| Rate for Payer: UHC Exchange |
$21,800.73
|
| Rate for Payer: UHCCP DNSP |
$14,064.99
|
| Rate for Payer: VA VA |
$14,064.99
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC
|
Facility
|
IP
|
$12,986.16
|
|
|
Service Code
|
MSDRG 060
|
| Min. Negotiated Rate |
$7,959.26 |
| Max. Negotiated Rate |
$12,986.16 |
| Rate for Payer: Aetna Medicare |
$8,378.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,472.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,472.71
|
| Rate for Payer: BCBS MAPPO |
$8,378.17
|
| Rate for Payer: BCN Medicare Advantage |
$8,378.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,378.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,378.17
|
| Rate for Payer: Mclaren Medicare |
$8,378.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,797.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,634.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,215.99
|
| Rate for Payer: PACE Medicare |
$7,959.26
|
| Rate for Payer: PACE SWMI |
$8,378.17
|
| Rate for Payer: PHP Commercial |
$9,215.99
|
| Rate for Payer: PHP Medicare Advantage |
$8,378.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12,636.95
|
| Rate for Payer: Priority Health Medicare |
$8,378.17
|
| Rate for Payer: Priority Health Narrow Network |
$10,109.56
|
| Rate for Payer: Railroad Medicare Medicare |
$8,378.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,378.17
|
| Rate for Payer: UHC Exchange |
$12,986.16
|
| Rate for Payer: UHCCP DNSP |
$8,378.17
|
| Rate for Payer: VA VA |
$8,378.17
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$4,221.18
|
|
|
Service Code
|
APR-DRG 0431
|
| Min. Negotiated Rate |
$3,816.45 |
| Max. Negotiated Rate |
$4,221.18 |
| Rate for Payer: BCBS Complete |
$4,221.18
|
| Rate for Payer: Mclaren Medicaid |
$4,020.17
|
| Rate for Payer: Meridian Medicaid |
$4,221.18
|
| Rate for Payer: PHP Medicaid |
$3,816.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,020.17
|
| Rate for Payer: UHC Medicaid |
$4,020.17
|
| Rate for Payer: UHCCP Medicaid |
$4,020.17
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$12,669.00
|
|
|
Service Code
|
APR-DRG 0433
|
| Min. Negotiated Rate |
$11,454.29 |
| Max. Negotiated Rate |
$12,669.00 |
| Rate for Payer: BCBS Complete |
$12,669.00
|
| Rate for Payer: Mclaren Medicaid |
$12,065.71
|
| Rate for Payer: Meridian Medicaid |
$12,669.00
|
| Rate for Payer: PHP Medicaid |
$11,454.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,065.71
|
| Rate for Payer: UHC Medicaid |
$12,065.71
|
| Rate for Payer: UHCCP Medicaid |
$12,065.71
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$5,100.73
|
|
|
Service Code
|
APR-DRG 0432
|
| Min. Negotiated Rate |
$4,611.67 |
| Max. Negotiated Rate |
$5,100.73 |
| Rate for Payer: BCBS Complete |
$5,100.73
|
| Rate for Payer: Mclaren Medicaid |
$4,857.84
|
| Rate for Payer: Meridian Medicaid |
$5,100.73
|
| Rate for Payer: PHP Medicaid |
$4,611.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,857.84
|
| Rate for Payer: UHC Medicaid |
$4,857.84
|
| Rate for Payer: UHCCP Medicaid |
$4,857.84
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$25,631.18
|
|
|
Service Code
|
APR-DRG 0434
|
| Min. Negotiated Rate |
$23,173.65 |
| Max. Negotiated Rate |
$25,631.18 |
| Rate for Payer: BCBS Complete |
$25,631.18
|
| Rate for Payer: Mclaren Medicaid |
$24,410.65
|
| Rate for Payer: Meridian Medicaid |
$25,631.18
|
| Rate for Payer: PHP Medicaid |
$23,173.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$24,410.65
|
| Rate for Payer: UHC Medicaid |
$24,410.65
|
| Rate for Payer: UHCCP Medicaid |
$24,410.65
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$10,517.53
|
|
|
Service Code
|
APR-DRG 9303
|
| Min. Negotiated Rate |
$9,509.11 |
| Max. Negotiated Rate |
$10,517.53 |
| Rate for Payer: BCBS Complete |
$10,517.53
|
| Rate for Payer: Mclaren Medicaid |
$10,016.70
|
| Rate for Payer: Meridian Medicaid |
$10,517.53
|
| Rate for Payer: PHP Medicaid |
$9,509.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,016.70
|
| Rate for Payer: UHC Medicaid |
$10,016.70
|
| Rate for Payer: UHCCP Medicaid |
$10,016.70
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$5,735.05
|
|
|
Service Code
|
APR-DRG 9302
|
| Min. Negotiated Rate |
$5,185.17 |
| Max. Negotiated Rate |
$5,735.05 |
| Rate for Payer: BCBS Complete |
$5,735.05
|
| Rate for Payer: Mclaren Medicaid |
$5,461.96
|
| Rate for Payer: Meridian Medicaid |
$5,735.05
|
| Rate for Payer: PHP Medicaid |
$5,185.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,461.96
|
| Rate for Payer: UHC Medicaid |
$5,461.96
|
| Rate for Payer: UHCCP Medicaid |
$5,461.96
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$14,177.96
|
|
|
Service Code
|
APR-DRG 9304
|
| Min. Negotiated Rate |
$12,818.58 |
| Max. Negotiated Rate |
$14,177.96 |
| Rate for Payer: BCBS Complete |
$14,177.96
|
| Rate for Payer: Mclaren Medicaid |
$13,502.82
|
| Rate for Payer: Meridian Medicaid |
$14,177.96
|
| Rate for Payer: PHP Medicaid |
$12,818.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,502.82
|
| Rate for Payer: UHC Medicaid |
$13,502.82
|
| Rate for Payer: UHCCP Medicaid |
$13,502.82
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$4,528.53
|
|
|
Service Code
|
APR-DRG 9301
|
| Min. Negotiated Rate |
$4,094.34 |
| Max. Negotiated Rate |
$4,528.53 |
| Rate for Payer: BCBS Complete |
$4,528.53
|
| Rate for Payer: Mclaren Medicaid |
$4,312.89
|
| Rate for Payer: Meridian Medicaid |
$4,528.53
|
| Rate for Payer: PHP Medicaid |
$4,094.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,312.89
|
| Rate for Payer: UHC Medicaid |
$4,312.89
|
| Rate for Payer: UHCCP Medicaid |
$4,312.89
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$207.90
|
|
|
Service Code
|
NDC 77333086110
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.92 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna Commercial |
$187.11
|
| Rate for Payer: Aetna Medicare |
$76.92
|
| Rate for Payer: ASR ASR |
$201.66
|
| Rate for Payer: BCBS Complete |
$83.16
|
| Rate for Payer: BCBS Trust/PPO |
$171.41
|
| Rate for Payer: BCN Commercial |
$171.41
|
| Rate for Payer: Cash Price |
$166.32
|
| Rate for Payer: Cofinity Commercial |
$195.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.32
|
| Rate for Payer: Healthscope Commercial |
$201.66
|
| Rate for Payer: Healthscope Whirlpool |
$207.90
|
| Rate for Payer: Mclaren Commercial |
$187.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.72
|
| Rate for Payer: Nomi Health Commercial |
$170.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$182.16
|
| Rate for Payer: Priority Health Narrow Network |
$145.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.95
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
NDC 904549261
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Aetna Medicare |
$66.60
|
| Rate for Payer: ASR ASR |
$174.60
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS Trust/PPO |
$148.41
|
| Rate for Payer: BCN Commercial |
$148.41
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$169.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$174.60
|
| Rate for Payer: Healthscope Whirlpool |
$180.00
|
| Rate for Payer: Mclaren Commercial |
$162.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: Nomi Health Commercial |
$147.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$157.72
|
| Rate for Payer: Priority Health Narrow Network |
$126.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.40
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$2.08
|
|
|
Service Code
|
NDC 77333086125
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$2.08 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: ASR ASR |
$2.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.71
|
| Rate for Payer: BCN Commercial |
$1.71
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$2.02
|
| Rate for Payer: Healthscope Whirlpool |
$2.08
|
| Rate for Payer: Mclaren Commercial |
$1.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Nomi Health Commercial |
$1.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.83
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$2.08
|
|
|
Service Code
|
NDC 77333086125
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$2.08 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Medicare |
$0.77
|
| Rate for Payer: ASR ASR |
$2.02
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: BCBS Trust/PPO |
$1.71
|
| Rate for Payer: BCN Commercial |
$1.71
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$2.02
|
| Rate for Payer: Healthscope Whirlpool |
$2.08
|
| Rate for Payer: Mclaren Commercial |
$1.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Nomi Health Commercial |
$1.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.82
|
| Rate for Payer: Priority Health Narrow Network |
$1.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.83
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
NDC 904549261
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: ASR ASR |
$174.60
|
| Rate for Payer: BCBS Trust/PPO |
$147.82
|
| Rate for Payer: BCN Commercial |
$147.82
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$169.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$174.60
|
| Rate for Payer: Healthscope Whirlpool |
$180.00
|
| Rate for Payer: Mclaren Commercial |
$162.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: Nomi Health Commercial |
$147.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.40
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$301.60
|
|
|
Service Code
|
NDC 40985022368
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$226.20 |
| Max. Negotiated Rate |
$301.60 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: ASR ASR |
$292.55
|
| Rate for Payer: BCBS Trust/PPO |
$247.67
|
| Rate for Payer: BCN Commercial |
$247.67
|
| Rate for Payer: Cash Price |
$241.28
|
| Rate for Payer: Cofinity Commercial |
$283.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.28
|
| Rate for Payer: Healthscope Commercial |
$292.55
|
| Rate for Payer: Healthscope Whirlpool |
$301.60
|
| Rate for Payer: Mclaren Commercial |
$271.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.36
|
| Rate for Payer: Nomi Health Commercial |
$247.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.41
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$207.90
|
|
|
Service Code
|
NDC 77333086110
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.93 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna Commercial |
$187.11
|
| Rate for Payer: ASR ASR |
$201.66
|
| Rate for Payer: BCBS Trust/PPO |
$170.73
|
| Rate for Payer: BCN Commercial |
$170.73
|
| Rate for Payer: Cash Price |
$166.32
|
| Rate for Payer: Cofinity Commercial |
$195.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.32
|
| Rate for Payer: Healthscope Commercial |
$201.66
|
| Rate for Payer: Healthscope Whirlpool |
$207.90
|
| Rate for Payer: Mclaren Commercial |
$187.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.72
|
| Rate for Payer: Nomi Health Commercial |
$170.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.95
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$301.60
|
|
|
Service Code
|
NDC 40985022368
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.59 |
| Max. Negotiated Rate |
$301.60 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Medicare |
$111.59
|
| Rate for Payer: ASR ASR |
$292.55
|
| Rate for Payer: BCBS Complete |
$120.64
|
| Rate for Payer: BCBS Trust/PPO |
$248.67
|
| Rate for Payer: BCN Commercial |
$248.67
|
| Rate for Payer: Cash Price |
$241.28
|
| Rate for Payer: Cofinity Commercial |
$283.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.28
|
| Rate for Payer: Healthscope Commercial |
$292.55
|
| Rate for Payer: Healthscope Whirlpool |
$301.60
|
| Rate for Payer: Mclaren Commercial |
$271.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.36
|
| Rate for Payer: Nomi Health Commercial |
$247.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$264.26
|
| Rate for Payer: Priority Health Narrow Network |
$211.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.41
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$20.79
|
|
|
Service Code
|
NDC 51672131200
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$20.79 |
| Rate for Payer: Aetna Commercial |
$18.71
|
| Rate for Payer: Aetna Medicare |
$7.69
|
| Rate for Payer: ASR ASR |
$20.17
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$17.14
|
| Rate for Payer: BCN Commercial |
$17.14
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cofinity Commercial |
$19.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.63
|
| Rate for Payer: Healthscope Commercial |
$20.17
|
| Rate for Payer: Healthscope Whirlpool |
$20.79
|
| Rate for Payer: Mclaren Commercial |
$18.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.67
|
| Rate for Payer: Nomi Health Commercial |
$17.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.22
|
| Rate for Payer: Priority Health Narrow Network |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.30
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$20.79
|
|
|
Service Code
|
NDC 51672131200
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.59 |
| Max. Negotiated Rate |
$20.79 |
| Rate for Payer: Aetna Commercial |
$18.71
|
| Rate for Payer: ASR ASR |
$20.17
|
| Rate for Payer: BCBS Trust/PPO |
$17.07
|
| Rate for Payer: BCN Commercial |
$17.07
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cofinity Commercial |
$19.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.63
|
| Rate for Payer: Healthscope Commercial |
$20.17
|
| Rate for Payer: Healthscope Whirlpool |
$20.79
|
| Rate for Payer: Mclaren Commercial |
$18.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.67
|
| Rate for Payer: Nomi Health Commercial |
$17.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.30
|
|
