|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$3.37
|
|
|
Service Code
|
NDC 50268016711
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: ASR ASR |
$3.26
|
| Rate for Payer: BCBS Trust/PPO |
$2.76
|
| Rate for Payer: BCN Commercial |
$2.76
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
| Rate for Payer: Healthscope Commercial |
$3.26
|
| Rate for Payer: Healthscope Whirlpool |
$3.37
|
| Rate for Payer: Mclaren Commercial |
$3.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.96
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
OP
|
$168.24
|
|
|
Service Code
|
NDC 50268016715
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.25 |
| Max. Negotiated Rate |
$168.24 |
| Rate for Payer: Aetna Commercial |
$151.42
|
| Rate for Payer: Aetna Medicare |
$62.25
|
| Rate for Payer: ASR ASR |
$163.19
|
| Rate for Payer: BCBS Complete |
$67.30
|
| Rate for Payer: BCBS Trust/PPO |
$138.71
|
| Rate for Payer: BCN Commercial |
$138.71
|
| Rate for Payer: Cash Price |
$134.59
|
| Rate for Payer: Cofinity Commercial |
$158.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.59
|
| Rate for Payer: Healthscope Commercial |
$163.19
|
| Rate for Payer: Healthscope Whirlpool |
$168.24
|
| Rate for Payer: Mclaren Commercial |
$151.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.00
|
| Rate for Payer: Nomi Health Commercial |
$137.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$147.41
|
| Rate for Payer: Priority Health Narrow Network |
$117.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.05
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
OP
|
$341.05
|
|
|
Service Code
|
NDC 43598071901
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.19 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Aetna Commercial |
$306.94
|
| Rate for Payer: Aetna Medicare |
$126.19
|
| Rate for Payer: ASR ASR |
$330.82
|
| Rate for Payer: BCBS Complete |
$136.42
|
| Rate for Payer: BCBS Trust/PPO |
$281.20
|
| Rate for Payer: BCN Commercial |
$281.20
|
| Rate for Payer: Cash Price |
$272.84
|
| Rate for Payer: Cofinity Commercial |
$320.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.84
|
| Rate for Payer: Healthscope Commercial |
$330.82
|
| Rate for Payer: Healthscope Whirlpool |
$341.05
|
| Rate for Payer: Mclaren Commercial |
$306.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.89
|
| Rate for Payer: Nomi Health Commercial |
$279.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$298.83
|
| Rate for Payer: Priority Health Narrow Network |
$239.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$300.12
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
OP
|
$213.75
|
|
|
Service Code
|
NDC 57664064888
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.09 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$192.38
|
| Rate for Payer: Aetna Medicare |
$79.09
|
| Rate for Payer: ASR ASR |
$207.34
|
| Rate for Payer: BCBS Complete |
$85.50
|
| Rate for Payer: BCBS Trust/PPO |
$176.24
|
| Rate for Payer: BCN Commercial |
$176.24
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cofinity Commercial |
$200.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.00
|
| Rate for Payer: Healthscope Commercial |
$207.34
|
| Rate for Payer: Healthscope Whirlpool |
$213.75
|
| Rate for Payer: Mclaren Commercial |
$192.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.69
|
| Rate for Payer: Nomi Health Commercial |
$175.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$187.29
|
| Rate for Payer: Priority Health Narrow Network |
$149.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.10
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
OP
|
$9.37
|
|
|
Service Code
|
NDC 51079005801
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$9.37 |
| Rate for Payer: Aetna Commercial |
$8.43
|
| Rate for Payer: Aetna Medicare |
$3.47
|
| Rate for Payer: ASR ASR |
$9.09
|
| Rate for Payer: BCBS Complete |
$3.75
|
| Rate for Payer: BCBS Trust/PPO |
$7.73
|
| Rate for Payer: BCN Commercial |
$7.73
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$8.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.50
|
| Rate for Payer: Healthscope Commercial |
$9.09
|
| Rate for Payer: Healthscope Whirlpool |
$9.37
|
| Rate for Payer: Mclaren Commercial |
$8.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.96
|
| Rate for Payer: Nomi Health Commercial |
$7.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.21
|
| Rate for Payer: Priority Health Narrow Network |
$6.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.25
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$205.34
|
|
|
Service Code
|
NDC 904690004
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.01 |
| Max. Negotiated Rate |
$205.34 |
| Rate for Payer: Aetna Commercial |
$184.81
|
| Rate for Payer: ASR ASR |
$199.18
|
| Rate for Payer: BCBS Trust/PPO |
$168.63
|
| Rate for Payer: BCN Commercial |
$168.63
|
| Rate for Payer: Cash Price |
$164.28
|
| Rate for Payer: Cofinity Commercial |
$193.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.28
|
| Rate for Payer: Healthscope Commercial |
$199.18
|
| Rate for Payer: Healthscope Whirlpool |
$205.34
|
| Rate for Payer: Mclaren Commercial |
$184.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.54
|
| Rate for Payer: Nomi Health Commercial |
$168.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.70
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$213.75
|
|
|
Service Code
|
NDC 57664064888
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.31 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$192.38
|
| Rate for Payer: ASR ASR |
$207.34
|
| Rate for Payer: BCBS Trust/PPO |
$175.53
|
| Rate for Payer: BCN Commercial |
$175.53
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cofinity Commercial |
$200.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.00
|
| Rate for Payer: Healthscope Commercial |
$207.34
|
| Rate for Payer: Healthscope Whirlpool |
$213.75
|
| Rate for Payer: Mclaren Commercial |
$192.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.69
|
| Rate for Payer: Nomi Health Commercial |
$175.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.10
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
OP
|
$242.05
|
|
|
Service Code
|
NDC 70756001111
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.56 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$217.84
|
| Rate for Payer: Aetna Medicare |
$89.56
|
| Rate for Payer: ASR ASR |
$234.79
|
| Rate for Payer: BCBS Complete |
$96.82
|
| Rate for Payer: BCBS Trust/PPO |
$199.57
|
| Rate for Payer: BCN Commercial |
$199.57
|
| Rate for Payer: Cash Price |
$193.64
|
| Rate for Payer: Cofinity Commercial |
$227.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.64
|
| Rate for Payer: Healthscope Commercial |
$234.79
|
| Rate for Payer: Healthscope Whirlpool |
$242.05
|
| Rate for Payer: Mclaren Commercial |
$217.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.74
|
| Rate for Payer: Nomi Health Commercial |
$198.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$212.08
|
| Rate for Payer: Priority Health Narrow Network |
$169.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.00
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
OP
|
$3.37
|
|
|
Service Code
|
NDC 50268016711
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: Aetna Medicare |
$1.25
|
| Rate for Payer: ASR ASR |
$3.26
|
| Rate for Payer: BCBS Complete |
$1.35
|
| Rate for Payer: BCBS Trust/PPO |
$2.77
|
| Rate for Payer: BCN Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
| Rate for Payer: Healthscope Commercial |
$3.26
|
| Rate for Payer: Healthscope Whirlpool |
$3.37
|
| Rate for Payer: Mclaren Commercial |
$3.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.95
|
| Rate for Payer: Priority Health Narrow Network |
$2.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.96
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
OP
|
$380.70
|
|
|
Service Code
|
NDC 75834002001
|
| Hospital Charge Code |
88945
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.86 |
| Max. Negotiated Rate |
$380.70 |
| Rate for Payer: Aetna Commercial |
$342.63
|
| Rate for Payer: Aetna Medicare |
$140.86
|
| Rate for Payer: ASR ASR |
$369.28
|
| Rate for Payer: BCBS Complete |
$152.28
|
| Rate for Payer: BCBS Trust/PPO |
$313.89
|
| Rate for Payer: BCN Commercial |
$313.89
|
| Rate for Payer: Cash Price |
$304.56
|
| Rate for Payer: Cofinity Commercial |
$357.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.56
|
| Rate for Payer: Healthscope Commercial |
$369.28
|
| Rate for Payer: Healthscope Whirlpool |
$380.70
|
| Rate for Payer: Mclaren Commercial |
$342.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$304.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.60
|
| Rate for Payer: Nomi Health Commercial |
$312.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$333.57
|
| Rate for Payer: Priority Health Narrow Network |
$266.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.02
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$380.70
|
|
|
Service Code
|
NDC 75834002001
|
| Hospital Charge Code |
88945
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$285.52 |
| Max. Negotiated Rate |
$380.70 |
| Rate for Payer: Aetna Commercial |
$342.63
|
| Rate for Payer: ASR ASR |
$369.28
|
| Rate for Payer: BCBS Trust/PPO |
$312.63
|
| Rate for Payer: BCN Commercial |
$312.63
|
| Rate for Payer: Cash Price |
$304.56
|
| Rate for Payer: Cofinity Commercial |
$357.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.56
|
| Rate for Payer: Healthscope Commercial |
$369.28
|
| Rate for Payer: Healthscope Whirlpool |
$380.70
|
| Rate for Payer: Mclaren Commercial |
$342.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.60
|
| Rate for Payer: Nomi Health Commercial |
$312.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.02
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
OP
|
$39.95
|
|
|
Service Code
|
NDC 80681016900
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Aetna Commercial |
$35.95
|
| Rate for Payer: Aetna Medicare |
$14.78
|
| Rate for Payer: ASR ASR |
$38.75
|
| Rate for Payer: BCBS Complete |
$15.98
|
| Rate for Payer: BCBS Trust/PPO |
$32.94
|
| Rate for Payer: BCN Commercial |
$32.94
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$37.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$38.75
|
| Rate for Payer: Healthscope Whirlpool |
$39.95
|
| Rate for Payer: Mclaren Commercial |
$35.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: Nomi Health Commercial |
$32.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$35.00
|
| Rate for Payer: Priority Health Narrow Network |
$28.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.16
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$212.80
|
|
|
Service Code
|
NDC 48433010401
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$212.80 |
| Rate for Payer: Aetna Commercial |
$191.52
|
| Rate for Payer: ASR ASR |
$206.42
|
| Rate for Payer: BCBS Trust/PPO |
$174.75
|
| Rate for Payer: BCN Commercial |
$174.75
|
| Rate for Payer: Cash Price |
$170.24
|
| Rate for Payer: Cofinity Commercial |
$200.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.24
|
| Rate for Payer: Healthscope Commercial |
$206.42
|
| Rate for Payer: Healthscope Whirlpool |
$212.80
|
| Rate for Payer: Mclaren Commercial |
$191.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.88
|
| Rate for Payer: Nomi Health Commercial |
$174.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.26
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$133.95
|
|
|
Service Code
|
NDC 31604001870
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$120.56
|
| Rate for Payer: ASR ASR |
$129.93
|
| Rate for Payer: BCBS Trust/PPO |
$110.00
|
| Rate for Payer: BCN Commercial |
$110.00
|
| Rate for Payer: Cash Price |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$125.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.16
|
| Rate for Payer: Healthscope Commercial |
$129.93
|
| Rate for Payer: Healthscope Whirlpool |
$133.95
|
| Rate for Payer: Mclaren Commercial |
$120.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.86
|
| Rate for Payer: Nomi Health Commercial |
$109.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.88
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
OP
|
$133.95
|
|
|
Service Code
|
NDC 31604001870
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.56 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$120.56
|
| Rate for Payer: Aetna Medicare |
$49.56
|
| Rate for Payer: ASR ASR |
$129.93
|
| Rate for Payer: BCBS Complete |
$53.58
|
| Rate for Payer: BCBS Trust/PPO |
$110.44
|
| Rate for Payer: BCN Commercial |
$110.44
|
| Rate for Payer: Cash Price |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$125.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.16
|
| Rate for Payer: Healthscope Commercial |
$129.93
|
| Rate for Payer: Healthscope Whirlpool |
$133.95
|
| Rate for Payer: Mclaren Commercial |
$120.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.86
|
| Rate for Payer: Nomi Health Commercial |
$109.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$117.37
|
| Rate for Payer: Priority Health Narrow Network |
$93.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.88
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$39.95
|
|
|
Service Code
|
NDC 80681016900
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.96 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Aetna Commercial |
$35.95
|
| Rate for Payer: ASR ASR |
$38.75
|
| Rate for Payer: BCBS Trust/PPO |
$32.81
|
| Rate for Payer: BCN Commercial |
$32.81
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$37.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$38.75
|
| Rate for Payer: Healthscope Whirlpool |
$39.95
|
| Rate for Payer: Mclaren Commercial |
$35.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: Nomi Health Commercial |
$32.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.16
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
OP
|
$212.80
|
|
|
Service Code
|
NDC 48433010401
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.74 |
| Max. Negotiated Rate |
$212.80 |
| Rate for Payer: Aetna Commercial |
$191.52
|
| Rate for Payer: Aetna Medicare |
$78.74
|
| Rate for Payer: ASR ASR |
$206.42
|
| Rate for Payer: BCBS Complete |
$85.12
|
| Rate for Payer: BCBS Trust/PPO |
$175.45
|
| Rate for Payer: BCN Commercial |
$175.45
|
| Rate for Payer: Cash Price |
$170.24
|
| Rate for Payer: Cofinity Commercial |
$200.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.24
|
| Rate for Payer: Healthscope Commercial |
$206.42
|
| Rate for Payer: Healthscope Whirlpool |
$212.80
|
| Rate for Payer: Mclaren Commercial |
$191.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$170.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.88
|
| Rate for Payer: Nomi Health Commercial |
$174.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$186.46
|
| Rate for Payer: Priority Health Narrow Network |
$149.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.26
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$12,066.83
|
|
|
Service Code
|
APR-DRG 2633
|
| Min. Negotiated Rate |
$10,909.86 |
| Max. Negotiated Rate |
$12,066.83 |
| Rate for Payer: BCBS Complete |
$12,066.83
|
| Rate for Payer: Mclaren Medicaid |
$11,492.22
|
| Rate for Payer: Meridian Medicaid |
$12,066.83
|
| Rate for Payer: PHP Medicaid |
$10,909.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,492.22
|
| Rate for Payer: UHC Medicaid |
$11,492.22
|
| Rate for Payer: UHCCP Medicaid |
$11,492.22
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$8,910.48
|
|
|
Service Code
|
APR-DRG 2632
|
| Min. Negotiated Rate |
$8,056.14 |
| Max. Negotiated Rate |
$8,910.48 |
| Rate for Payer: BCBS Complete |
$8,910.48
|
| Rate for Payer: Mclaren Medicaid |
$8,486.17
|
| Rate for Payer: Meridian Medicaid |
$8,910.48
|
| Rate for Payer: PHP Medicaid |
$8,056.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,486.17
|
| Rate for Payer: UHC Medicaid |
$8,486.17
|
| Rate for Payer: UHCCP Medicaid |
$8,486.17
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$6,939.39
|
|
|
Service Code
|
APR-DRG 2631
|
| Min. Negotiated Rate |
$6,274.04 |
| Max. Negotiated Rate |
$6,939.39 |
| Rate for Payer: BCBS Complete |
$6,939.39
|
| Rate for Payer: Mclaren Medicaid |
$6,608.95
|
| Rate for Payer: Meridian Medicaid |
$6,939.39
|
| Rate for Payer: PHP Medicaid |
$6,274.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,608.95
|
| Rate for Payer: UHC Medicaid |
$6,608.95
|
| Rate for Payer: UHCCP Medicaid |
$6,608.95
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$19,934.82
|
|
|
Service Code
|
APR-DRG 2634
|
| Min. Negotiated Rate |
$18,023.46 |
| Max. Negotiated Rate |
$19,934.82 |
| Rate for Payer: BCBS Complete |
$19,934.82
|
| Rate for Payer: Mclaren Medicaid |
$18,985.54
|
| Rate for Payer: Meridian Medicaid |
$19,934.82
|
| Rate for Payer: PHP Medicaid |
$18,023.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,985.54
|
| Rate for Payer: UHC Medicaid |
$18,985.54
|
| Rate for Payer: UHCCP Medicaid |
$18,985.54
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$28,393.98
|
|
|
Service Code
|
MSDRG 415
|
| Min. Negotiated Rate |
$15,805.42 |
| Max. Negotiated Rate |
$28,393.98 |
| Rate for Payer: Aetna Medicare |
$16,637.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,796.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,796.60
|
| Rate for Payer: BCBS MAPPO |
$16,637.28
|
| Rate for Payer: BCN Medicare Advantage |
$16,637.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,637.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,637.28
|
| Rate for Payer: Mclaren Medicare |
$16,637.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,469.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,132.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,301.01
|
| Rate for Payer: PACE Medicare |
$15,805.42
|
| Rate for Payer: PACE SWMI |
$16,637.28
|
| Rate for Payer: PHP Commercial |
$18,301.01
|
| Rate for Payer: PHP Medicare Advantage |
$16,637.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28,393.98
|
| Rate for Payer: Priority Health Medicare |
$16,637.28
|
| Rate for Payer: Priority Health Narrow Network |
$22,715.18
|
| Rate for Payer: Railroad Medicare Medicare |
$16,637.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,637.28
|
| Rate for Payer: UHC Exchange |
$25,787.78
|
| Rate for Payer: UHCCP DNSP |
$16,637.28
|
| Rate for Payer: VA VA |
$16,637.28
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$48,945.85
|
|
|
Service Code
|
MSDRG 414
|
| Min. Negotiated Rate |
$26,039.13 |
| Max. Negotiated Rate |
$48,945.85 |
| Rate for Payer: Aetna Medicare |
$27,409.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,262.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,262.01
|
| Rate for Payer: BCBS MAPPO |
$27,409.61
|
| Rate for Payer: BCN Medicare Advantage |
$27,409.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,409.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$27,409.61
|
| Rate for Payer: Mclaren Medicare |
$27,409.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28,780.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,521.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$30,150.57
|
| Rate for Payer: PACE Medicare |
$26,039.13
|
| Rate for Payer: PACE SWMI |
$27,409.61
|
| Rate for Payer: PHP Commercial |
$30,150.57
|
| Rate for Payer: PHP Medicare Advantage |
$27,409.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$48,945.85
|
| Rate for Payer: Priority Health Medicare |
$27,409.61
|
| Rate for Payer: Priority Health Narrow Network |
$39,156.68
|
| Rate for Payer: Railroad Medicare Medicare |
$27,409.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27,409.61
|
| Rate for Payer: UHC Exchange |
$42,484.90
|
| Rate for Payer: UHCCP DNSP |
$27,409.61
|
| Rate for Payer: VA VA |
$27,409.61
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$18,730.11
|
|
|
Service Code
|
MSDRG 416
|
| Min. Negotiated Rate |
$10,993.31 |
| Max. Negotiated Rate |
$18,730.11 |
| Rate for Payer: Aetna Medicare |
$11,571.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,464.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,464.89
|
| Rate for Payer: BCBS MAPPO |
$11,571.91
|
| Rate for Payer: BCN Medicare Advantage |
$11,571.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,571.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,571.91
|
| Rate for Payer: Mclaren Medicare |
$11,571.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,150.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,307.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,729.10
|
| Rate for Payer: PACE Medicare |
$10,993.31
|
| Rate for Payer: PACE SWMI |
$11,571.91
|
| Rate for Payer: PHP Commercial |
$12,729.10
|
| Rate for Payer: PHP Medicare Advantage |
$11,571.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18,730.11
|
| Rate for Payer: Priority Health Medicare |
$11,571.91
|
| Rate for Payer: Priority Health Narrow Network |
$14,984.08
|
| Rate for Payer: Railroad Medicare Medicare |
$11,571.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,571.91
|
| Rate for Payer: UHC Exchange |
$17,936.46
|
| Rate for Payer: UHCCP DNSP |
$11,571.91
|
| Rate for Payer: VA VA |
$11,571.91
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITH CC
|
Facility
|
IP
|
$28,885.83
|
|
|
Service Code
|
MSDRG 412
|
| Min. Negotiated Rate |
$16,050.32 |
| Max. Negotiated Rate |
$28,885.83 |
| Rate for Payer: Aetna Medicare |
$16,895.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,118.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,118.84
|
| Rate for Payer: BCBS MAPPO |
$16,895.07
|
| Rate for Payer: BCN Medicare Advantage |
$16,895.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,895.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,895.07
|
| Rate for Payer: Mclaren Medicare |
$16,895.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,739.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,429.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,584.58
|
| Rate for Payer: PACE Medicare |
$16,050.32
|
| Rate for Payer: PACE SWMI |
$16,895.07
|
| Rate for Payer: PHP Commercial |
$18,584.58
|
| Rate for Payer: PHP Medicare Advantage |
$16,895.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28,885.83
|
| Rate for Payer: Priority Health Medicare |
$16,895.07
|
| Rate for Payer: Priority Health Narrow Network |
$23,108.66
|
| Rate for Payer: Railroad Medicare Medicare |
$16,895.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,895.07
|
| Rate for Payer: UHC Exchange |
$26,187.36
|
| Rate for Payer: UHCCP DNSP |
$16,895.07
|
| Rate for Payer: VA VA |
$16,895.07
|
|
