|
NEPHRITIS AND NEPHROSIS
|
Facility
|
IP
|
$20,647.07
|
|
|
Service Code
|
APR-DRG 4624
|
| Min. Negotiated Rate |
$18,667.42 |
| Max. Negotiated Rate |
$20,647.07 |
| Rate for Payer: BCBS Complete |
$20,647.07
|
| Rate for Payer: Mclaren Medicaid |
$19,663.87
|
| Rate for Payer: Meridian Medicaid |
$20,647.07
|
| Rate for Payer: PHP Medicaid |
$18,667.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,663.87
|
| Rate for Payer: UHC Medicaid |
$19,663.87
|
| Rate for Payer: UHCCP Medicaid |
$19,663.87
|
|
|
NERVOUS SYSTEM MALIGNANCY
|
Facility
|
IP
|
$5,309.45
|
|
|
Service Code
|
APR-DRG 0412
|
| Min. Negotiated Rate |
$4,800.38 |
| Max. Negotiated Rate |
$5,309.45 |
| Rate for Payer: BCBS Complete |
$5,309.45
|
| Rate for Payer: Mclaren Medicaid |
$5,056.62
|
| Rate for Payer: Meridian Medicaid |
$5,309.45
|
| Rate for Payer: PHP Medicaid |
$4,800.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,056.62
|
| Rate for Payer: UHC Medicaid |
$5,056.62
|
| Rate for Payer: UHCCP Medicaid |
$5,056.62
|
|
|
NERVOUS SYSTEM MALIGNANCY
|
Facility
|
IP
|
$11,015.07
|
|
|
Service Code
|
APR-DRG 0414
|
| Min. Negotiated Rate |
$9,958.95 |
| Max. Negotiated Rate |
$11,015.07 |
| Rate for Payer: BCBS Complete |
$11,015.07
|
| Rate for Payer: Mclaren Medicaid |
$10,490.55
|
| Rate for Payer: Meridian Medicaid |
$11,015.07
|
| Rate for Payer: PHP Medicaid |
$9,958.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,490.55
|
| Rate for Payer: UHC Medicaid |
$10,490.55
|
| Rate for Payer: UHCCP Medicaid |
$10,490.55
|
|
|
NERVOUS SYSTEM MALIGNANCY
|
Facility
|
IP
|
$8,025.48
|
|
|
Service Code
|
APR-DRG 0413
|
| Min. Negotiated Rate |
$7,255.99 |
| Max. Negotiated Rate |
$8,025.48 |
| Rate for Payer: BCBS Complete |
$8,025.48
|
| Rate for Payer: Mclaren Medicaid |
$7,643.31
|
| Rate for Payer: Meridian Medicaid |
$8,025.48
|
| Rate for Payer: PHP Medicaid |
$7,255.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,643.31
|
| Rate for Payer: UHC Medicaid |
$7,643.31
|
| Rate for Payer: UHCCP Medicaid |
$7,643.31
|
|
|
NERVOUS SYSTEM MALIGNANCY
|
Facility
|
IP
|
$4,080.59
|
|
|
Service Code
|
APR-DRG 0411
|
| Min. Negotiated Rate |
$3,689.34 |
| Max. Negotiated Rate |
$4,080.59 |
| Rate for Payer: BCBS Complete |
$4,080.59
|
| Rate for Payer: Mclaren Medicaid |
$3,886.27
|
| Rate for Payer: Meridian Medicaid |
$4,080.59
|
| Rate for Payer: PHP Medicaid |
$3,689.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,886.27
|
| Rate for Payer: UHC Medicaid |
$3,886.27
|
| Rate for Payer: UHCCP Medicaid |
$3,886.27
|
|
|
NERVOUS SYSTEM NEOPLASMS WITH MCC
|
Facility
|
IP
|
$20,977.77
|
|
|
Service Code
|
MSDRG 054
|
| Min. Negotiated Rate |
$12,112.54 |
| Max. Negotiated Rate |
$20,977.77 |
| Rate for Payer: Aetna Medicare |
$12,750.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,937.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,937.55
|
| Rate for Payer: BCBS MAPPO |
$12,750.04
|
| Rate for Payer: BCN Medicare Advantage |
$12,750.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,750.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,750.04
|
| Rate for Payer: Mclaren Medicare |
$12,750.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,387.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,662.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,025.04
|
| Rate for Payer: PACE Medicare |
$12,112.54
|
| Rate for Payer: PACE SWMI |
$12,750.04
|
| Rate for Payer: PHP Commercial |
$14,025.04
|
| Rate for Payer: PHP Medicare Advantage |
$12,750.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20,977.77
|
| Rate for Payer: Priority Health Medicare |
$12,750.04
|
| Rate for Payer: Priority Health Narrow Network |
$16,782.22
|
| Rate for Payer: Railroad Medicare Medicare |
$12,750.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,750.04
|
| Rate for Payer: UHC Exchange |
$19,762.56
|
| Rate for Payer: UHCCP DNSP |
$12,750.04
|
| Rate for Payer: VA VA |
$12,750.04
|
|
|
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC
|
Facility
|
IP
|
$14,100.10
|
|
|
Service Code
|
MSDRG 055
|
| Min. Negotiated Rate |
$8,642.00 |
| Max. Negotiated Rate |
$14,100.10 |
| Rate for Payer: Aetna Medicare |
$9,096.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,371.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,371.05
|
| Rate for Payer: BCBS MAPPO |
$9,096.84
|
| Rate for Payer: BCN Medicare Advantage |
$9,096.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,096.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,096.84
|
| Rate for Payer: Mclaren Medicare |
$9,096.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,551.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,461.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,006.52
|
| Rate for Payer: PACE Medicare |
$8,642.00
|
| Rate for Payer: PACE SWMI |
$9,096.84
|
| Rate for Payer: PHP Commercial |
$10,006.52
|
| Rate for Payer: PHP Medicare Advantage |
$9,096.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,008.08
|
| Rate for Payer: Priority Health Medicare |
$9,096.84
|
| Rate for Payer: Priority Health Narrow Network |
$11,206.46
|
| Rate for Payer: Railroad Medicare Medicare |
$9,096.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,096.84
|
| Rate for Payer: UHC Exchange |
$14,100.10
|
| Rate for Payer: UHCCP DNSP |
$9,096.84
|
| Rate for Payer: VA VA |
$9,096.84
|
|
|
NEUROLOGICAL EYE DISORDERS
|
Facility
|
IP
|
$11,633.32
|
|
|
Service Code
|
MSDRG 123
|
| Min. Negotiated Rate |
$7,130.10 |
| Max. Negotiated Rate |
$11,633.32 |
| Rate for Payer: Aetna Medicare |
$7,505.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,381.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,381.71
|
| Rate for Payer: BCBS MAPPO |
$7,505.37
|
| Rate for Payer: BCN Medicare Advantage |
$7,505.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,505.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,505.37
|
| Rate for Payer: Mclaren Medicare |
$7,505.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,880.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,631.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,255.91
|
| Rate for Payer: PACE Medicare |
$7,130.10
|
| Rate for Payer: PACE SWMI |
$7,505.37
|
| Rate for Payer: PHP Commercial |
$8,255.91
|
| Rate for Payer: PHP Medicare Advantage |
$7,505.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,971.81
|
| Rate for Payer: Priority Health Medicare |
$7,505.37
|
| Rate for Payer: Priority Health Narrow Network |
$8,777.44
|
| Rate for Payer: Railroad Medicare Medicare |
$7,505.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,505.37
|
| Rate for Payer: UHC Exchange |
$11,633.32
|
| Rate for Payer: UHCCP DNSP |
$7,505.37
|
| Rate for Payer: VA VA |
$7,505.37
|
|
|
NEUROSES EXCEPT DEPRESSIVE
|
Facility
|
IP
|
$14,752.72
|
|
|
Service Code
|
MSDRG 882
|
| Min. Negotiated Rate |
$9,012.79 |
| Max. Negotiated Rate |
$14,752.72 |
| Rate for Payer: Aetna Medicare |
$9,487.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,858.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,858.94
|
| Rate for Payer: BCBS MAPPO |
$9,487.15
|
| Rate for Payer: BCN Medicare Advantage |
$9,487.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,487.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,487.15
|
| Rate for Payer: Mclaren Medicare |
$9,487.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,961.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,910.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,435.86
|
| Rate for Payer: PACE Medicare |
$9,012.79
|
| Rate for Payer: PACE SWMI |
$9,487.15
|
| Rate for Payer: PHP Commercial |
$10,435.86
|
| Rate for Payer: PHP Medicare Advantage |
$9,487.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,752.72
|
| Rate for Payer: Priority Health Medicare |
$9,487.15
|
| Rate for Payer: Priority Health Narrow Network |
$11,802.18
|
| Rate for Payer: Railroad Medicare Medicare |
$9,487.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,487.15
|
| Rate for Payer: UHC Exchange |
$14,705.08
|
| Rate for Payer: UHCCP DNSP |
$9,487.15
|
| Rate for Payer: VA VA |
$9,487.15
|
|
|
NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN
|
Facility
|
IP
|
$270.98
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
94576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$203.23 |
| Max. Negotiated Rate |
$270.98 |
| Rate for Payer: Aetna Commercial |
$243.88
|
| Rate for Payer: Aetna Commercial |
$283.97
|
| Rate for Payer: ASR ASR |
$306.05
|
| Rate for Payer: ASR ASR |
$262.85
|
| Rate for Payer: BCBS Trust/PPO |
$259.11
|
| Rate for Payer: BCBS Trust/PPO |
$222.53
|
| Rate for Payer: BCN Commercial |
$259.11
|
| Rate for Payer: BCN Commercial |
$222.53
|
| Rate for Payer: Cash Price |
$252.42
|
| Rate for Payer: Cash Price |
$216.78
|
| Rate for Payer: Cofinity Commercial |
$254.72
|
| Rate for Payer: Cofinity Commercial |
$296.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.78
|
| Rate for Payer: Healthscope Commercial |
$262.85
|
| Rate for Payer: Healthscope Commercial |
$306.05
|
| Rate for Payer: Healthscope Whirlpool |
$315.52
|
| Rate for Payer: Healthscope Whirlpool |
$270.98
|
| Rate for Payer: Mclaren Commercial |
$283.97
|
| Rate for Payer: Mclaren Commercial |
$243.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.33
|
| Rate for Payer: Nomi Health Commercial |
$258.73
|
| Rate for Payer: Nomi Health Commercial |
$222.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.66
|
|
|
NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN
|
Facility
|
OP
|
$315.52
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
94576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$315.52 |
| Rate for Payer: Aetna Commercial |
$283.97
|
| Rate for Payer: Aetna Commercial |
$243.88
|
| Rate for Payer: Aetna Medicare |
$100.26
|
| Rate for Payer: Aetna Medicare |
$116.74
|
| Rate for Payer: ASR ASR |
$306.05
|
| Rate for Payer: ASR ASR |
$262.85
|
| Rate for Payer: BCBS Complete |
$108.39
|
| Rate for Payer: BCBS Complete |
$126.21
|
| Rate for Payer: BCBS Trust/PPO |
$260.15
|
| Rate for Payer: BCBS Trust/PPO |
$223.42
|
| Rate for Payer: BCN Commercial |
$223.42
|
| Rate for Payer: BCN Commercial |
$260.15
|
| Rate for Payer: Cash Price |
$252.42
|
| Rate for Payer: Cash Price |
$216.78
|
| Rate for Payer: Cash Price |
$252.42
|
| Rate for Payer: Cash Price |
$216.78
|
| Rate for Payer: Cofinity Commercial |
$254.72
|
| Rate for Payer: Cofinity Commercial |
$296.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.78
|
| Rate for Payer: Healthscope Commercial |
$306.05
|
| Rate for Payer: Healthscope Commercial |
$262.85
|
| Rate for Payer: Healthscope Whirlpool |
$315.52
|
| Rate for Payer: Healthscope Whirlpool |
$270.98
|
| Rate for Payer: Mclaren Commercial |
$283.97
|
| Rate for Payer: Mclaren Commercial |
$243.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.19
|
| Rate for Payer: Nomi Health Commercial |
$222.20
|
| Rate for Payer: Nomi Health Commercial |
$258.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.66
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$7.65
|
|
|
Service Code
|
NDC 43598044771
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$6.89
|
| Rate for Payer: ASR ASR |
$7.42
|
| Rate for Payer: BCBS Trust/PPO |
$6.28
|
| Rate for Payer: BCN Commercial |
$6.28
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cofinity Commercial |
$7.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.12
|
| Rate for Payer: Healthscope Commercial |
$7.42
|
| Rate for Payer: Healthscope Whirlpool |
$7.65
|
| Rate for Payer: Mclaren Commercial |
$6.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.50
|
| Rate for Payer: Nomi Health Commercial |
$6.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.73
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$174.77
|
|
|
Service Code
|
NDC 766143020
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.08 |
| Max. Negotiated Rate |
$174.77 |
| Rate for Payer: Aetna Commercial |
$157.30
|
| Rate for Payer: ASR ASR |
$169.53
|
| Rate for Payer: BCBS Trust/PPO |
$143.52
|
| Rate for Payer: BCN Commercial |
$143.52
|
| Rate for Payer: Cash Price |
$139.82
|
| Rate for Payer: Cofinity Commercial |
$164.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.82
|
| Rate for Payer: Healthscope Commercial |
$169.53
|
| Rate for Payer: Healthscope Whirlpool |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$157.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.56
|
| Rate for Payer: Nomi Health Commercial |
$143.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.80
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$8.62
|
|
|
Service Code
|
NDC 60505706200
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: Aetna Commercial |
$7.76
|
| Rate for Payer: ASR ASR |
$8.36
|
| Rate for Payer: BCBS Trust/PPO |
$7.08
|
| Rate for Payer: BCN Commercial |
$7.08
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$8.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$8.36
|
| Rate for Payer: Healthscope Whirlpool |
$8.62
|
| Rate for Payer: Mclaren Commercial |
$7.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.33
|
| Rate for Payer: Nomi Health Commercial |
$7.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.59
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$7.65
|
|
|
Service Code
|
NDC 43598044771
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$6.89
|
| Rate for Payer: Aetna Medicare |
$2.83
|
| Rate for Payer: ASR ASR |
$7.42
|
| Rate for Payer: BCBS Complete |
$3.06
|
| Rate for Payer: BCBS Trust/PPO |
$6.31
|
| Rate for Payer: BCN Commercial |
$6.31
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cofinity Commercial |
$7.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.12
|
| Rate for Payer: Healthscope Commercial |
$7.42
|
| Rate for Payer: Healthscope Whirlpool |
$7.65
|
| Rate for Payer: Mclaren Commercial |
$6.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.50
|
| Rate for Payer: Nomi Health Commercial |
$6.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.70
|
| Rate for Payer: Priority Health Narrow Network |
$5.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.73
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$120.69
|
|
|
Service Code
|
NDC 60505708900
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.52 |
| Max. Negotiated Rate |
$120.69 |
| Rate for Payer: Aetna Commercial |
$108.62
|
| Rate for Payer: ASR ASR |
$117.07
|
| Rate for Payer: BCBS Trust/PPO |
$99.11
|
| Rate for Payer: BCN Commercial |
$99.11
|
| Rate for Payer: Cash Price |
$96.55
|
| Rate for Payer: Cofinity Commercial |
$113.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.55
|
| Rate for Payer: Healthscope Commercial |
$117.07
|
| Rate for Payer: Healthscope Whirlpool |
$120.69
|
| Rate for Payer: Mclaren Commercial |
$108.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.59
|
| Rate for Payer: Nomi Health Commercial |
$98.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.21
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$8.62
|
|
|
Service Code
|
NDC 60505706200
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: Aetna Commercial |
$7.76
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: ASR ASR |
$8.36
|
| Rate for Payer: BCBS Complete |
$3.45
|
| Rate for Payer: BCBS Trust/PPO |
$7.11
|
| Rate for Payer: BCN Commercial |
$7.11
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$8.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$8.36
|
| Rate for Payer: Healthscope Whirlpool |
$8.62
|
| Rate for Payer: Mclaren Commercial |
$7.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.33
|
| Rate for Payer: Nomi Health Commercial |
$7.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.55
|
| Rate for Payer: Priority Health Narrow Network |
$6.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.59
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$64.31
|
|
|
Service Code
|
NDC 536589553
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.23 |
| Max. Negotiated Rate |
$64.31 |
| Rate for Payer: Aetna Commercial |
$57.88
|
| Rate for Payer: ASR ASR |
$62.38
|
| Rate for Payer: BCBS Trust/PPO |
$52.81
|
| Rate for Payer: BCN Commercial |
$52.81
|
| Rate for Payer: Cash Price |
$51.45
|
| Rate for Payer: Cofinity Commercial |
$60.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.45
|
| Rate for Payer: Healthscope Commercial |
$62.38
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| Rate for Payer: Mclaren Commercial |
$57.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.66
|
| Rate for Payer: Nomi Health Commercial |
$52.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.59
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$62.30
|
|
|
Service Code
|
NDC 43598044770
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.05 |
| Max. Negotiated Rate |
$62.30 |
| Rate for Payer: Aetna Commercial |
$56.07
|
| Rate for Payer: Aetna Medicare |
$23.05
|
| Rate for Payer: ASR ASR |
$60.43
|
| Rate for Payer: BCBS Complete |
$24.92
|
| Rate for Payer: BCBS Trust/PPO |
$51.36
|
| Rate for Payer: BCN Commercial |
$51.36
|
| Rate for Payer: Cash Price |
$49.84
|
| Rate for Payer: Cofinity Commercial |
$58.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.84
|
| Rate for Payer: Healthscope Commercial |
$60.43
|
| Rate for Payer: Healthscope Whirlpool |
$62.30
|
| Rate for Payer: Mclaren Commercial |
$56.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.95
|
| Rate for Payer: Nomi Health Commercial |
$51.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.58
|
| Rate for Payer: Priority Health Narrow Network |
$43.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.82
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$174.77
|
|
|
Service Code
|
NDC 766143020
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.67 |
| Max. Negotiated Rate |
$174.77 |
| Rate for Payer: Aetna Commercial |
$157.30
|
| Rate for Payer: Aetna Medicare |
$64.67
|
| Rate for Payer: ASR ASR |
$169.53
|
| Rate for Payer: BCBS Complete |
$69.91
|
| Rate for Payer: BCBS Trust/PPO |
$144.10
|
| Rate for Payer: BCN Commercial |
$144.10
|
| Rate for Payer: Cash Price |
$139.82
|
| Rate for Payer: Cofinity Commercial |
$164.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.82
|
| Rate for Payer: Healthscope Commercial |
$169.53
|
| Rate for Payer: Healthscope Whirlpool |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$157.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.56
|
| Rate for Payer: Nomi Health Commercial |
$143.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$153.14
|
| Rate for Payer: Priority Health Narrow Network |
$122.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.80
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$64.31
|
|
|
Service Code
|
NDC 536589553
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$64.31 |
| Rate for Payer: Aetna Commercial |
$57.88
|
| Rate for Payer: Aetna Medicare |
$23.80
|
| Rate for Payer: ASR ASR |
$62.38
|
| Rate for Payer: BCBS Complete |
$25.72
|
| Rate for Payer: BCBS Trust/PPO |
$53.02
|
| Rate for Payer: BCN Commercial |
$53.02
|
| Rate for Payer: Cash Price |
$51.45
|
| Rate for Payer: Cofinity Commercial |
$60.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.45
|
| Rate for Payer: Healthscope Commercial |
$62.38
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| Rate for Payer: Mclaren Commercial |
$57.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.66
|
| Rate for Payer: Nomi Health Commercial |
$52.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$56.35
|
| Rate for Payer: Priority Health Narrow Network |
$45.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.59
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$89.31
|
|
|
Service Code
|
NDC 536589588
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.98 |
| Max. Negotiated Rate |
$89.31 |
| Rate for Payer: Aetna Commercial |
$80.38
|
| Rate for Payer: ASR ASR |
$86.63
|
| Rate for Payer: BCBS Trust/PPO |
$73.34
|
| Rate for Payer: BCN Commercial |
$73.34
|
| Rate for Payer: Cash Price |
$71.45
|
| Rate for Payer: Cofinity Commercial |
$83.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.45
|
| Rate for Payer: Healthscope Commercial |
$86.63
|
| Rate for Payer: Healthscope Whirlpool |
$89.31
|
| Rate for Payer: Mclaren Commercial |
$80.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: Nomi Health Commercial |
$73.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.59
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$89.31
|
|
|
Service Code
|
NDC 536589588
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.04 |
| Max. Negotiated Rate |
$89.31 |
| Rate for Payer: Aetna Commercial |
$80.38
|
| Rate for Payer: Aetna Medicare |
$33.04
|
| Rate for Payer: ASR ASR |
$86.63
|
| Rate for Payer: BCBS Complete |
$35.72
|
| Rate for Payer: BCBS Trust/PPO |
$73.64
|
| Rate for Payer: BCN Commercial |
$73.64
|
| Rate for Payer: Cash Price |
$71.45
|
| Rate for Payer: Cofinity Commercial |
$83.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.45
|
| Rate for Payer: Healthscope Commercial |
$86.63
|
| Rate for Payer: Healthscope Whirlpool |
$89.31
|
| Rate for Payer: Mclaren Commercial |
$80.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: Nomi Health Commercial |
$73.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$78.25
|
| Rate for Payer: Priority Health Narrow Network |
$62.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.59
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
OP
|
$120.69
|
|
|
Service Code
|
NDC 60505708900
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.66 |
| Max. Negotiated Rate |
$120.69 |
| Rate for Payer: Aetna Commercial |
$108.62
|
| Rate for Payer: Aetna Medicare |
$44.66
|
| Rate for Payer: ASR ASR |
$117.07
|
| Rate for Payer: BCBS Complete |
$48.28
|
| Rate for Payer: BCBS Trust/PPO |
$99.51
|
| Rate for Payer: BCN Commercial |
$99.51
|
| Rate for Payer: Cash Price |
$96.55
|
| Rate for Payer: Cofinity Commercial |
$113.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.55
|
| Rate for Payer: Healthscope Commercial |
$117.07
|
| Rate for Payer: Healthscope Whirlpool |
$120.69
|
| Rate for Payer: Mclaren Commercial |
$108.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.59
|
| Rate for Payer: Nomi Health Commercial |
$98.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$105.75
|
| Rate for Payer: Priority Health Narrow Network |
$84.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.21
|
|
|
NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH
|
Facility
|
IP
|
$62.30
|
|
|
Service Code
|
NDC 43598044770
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.72 |
| Max. Negotiated Rate |
$62.30 |
| Rate for Payer: Aetna Commercial |
$56.07
|
| Rate for Payer: ASR ASR |
$60.43
|
| Rate for Payer: BCBS Trust/PPO |
$51.16
|
| Rate for Payer: BCN Commercial |
$51.16
|
| Rate for Payer: Cash Price |
$49.84
|
| Rate for Payer: Cofinity Commercial |
$58.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.84
|
| Rate for Payer: Healthscope Commercial |
$60.43
|
| Rate for Payer: Healthscope Whirlpool |
$62.30
|
| Rate for Payer: Mclaren Commercial |
$56.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.95
|
| Rate for Payer: Nomi Health Commercial |
$51.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.82
|
|
