|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
OP
|
$261.56
|
|
|
Service Code
|
NDC 72485062513
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.78 |
| Max. Negotiated Rate |
$261.56 |
| Rate for Payer: Aetna Commercial |
$235.40
|
| Rate for Payer: Aetna Medicare |
$96.78
|
| Rate for Payer: ASR ASR |
$253.71
|
| Rate for Payer: BCBS Complete |
$104.62
|
| Rate for Payer: BCBS Trust/PPO |
$215.65
|
| Rate for Payer: BCN Commercial |
$215.65
|
| Rate for Payer: Cash Price |
$209.24
|
| Rate for Payer: Cofinity Commercial |
$245.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.24
|
| Rate for Payer: Healthscope Commercial |
$253.71
|
| Rate for Payer: Healthscope Whirlpool |
$261.56
|
| Rate for Payer: Mclaren Commercial |
$235.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.32
|
| Rate for Payer: Nomi Health Commercial |
$214.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$229.17
|
| Rate for Payer: Priority Health Narrow Network |
$183.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.17
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION
|
Facility
|
OP
|
$375.48
|
|
|
Service Code
|
NDC 43598032675
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.93 |
| Max. Negotiated Rate |
$375.48 |
| Rate for Payer: Aetna Commercial |
$337.93
|
| Rate for Payer: Aetna Medicare |
$138.93
|
| Rate for Payer: ASR ASR |
$364.22
|
| Rate for Payer: BCBS Complete |
$150.19
|
| Rate for Payer: BCBS Trust/PPO |
$309.58
|
| Rate for Payer: BCN Commercial |
$309.58
|
| Rate for Payer: Cash Price |
$300.38
|
| Rate for Payer: Cofinity Commercial |
$352.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.38
|
| Rate for Payer: Healthscope Commercial |
$364.22
|
| Rate for Payer: Healthscope Whirlpool |
$375.48
|
| Rate for Payer: Mclaren Commercial |
$337.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.16
|
| Rate for Payer: Nomi Health Commercial |
$307.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$329.00
|
| Rate for Payer: Priority Health Narrow Network |
$263.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.42
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$22.14
|
|
|
Service Code
|
NDC 69315030802
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$22.14 |
| Rate for Payer: Aetna Commercial |
$19.93
|
| Rate for Payer: ASR ASR |
$21.48
|
| Rate for Payer: BCBS Trust/PPO |
$18.18
|
| Rate for Payer: BCN Commercial |
$18.18
|
| Rate for Payer: Cash Price |
$17.71
|
| Rate for Payer: Cofinity Commercial |
$20.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.71
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Healthscope Whirlpool |
$22.14
|
| Rate for Payer: Mclaren Commercial |
$19.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.82
|
| Rate for Payer: Nomi Health Commercial |
$18.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.48
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$24.50
|
|
|
Service Code
|
NDC 17478071425
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: Aetna Medicare |
$9.06
|
| Rate for Payer: ASR ASR |
$23.77
|
| Rate for Payer: BCBS Complete |
$9.80
|
| Rate for Payer: BCBS Trust/PPO |
$20.20
|
| Rate for Payer: BCN Commercial |
$20.20
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Cofinity Commercial |
$23.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.60
|
| Rate for Payer: Healthscope Commercial |
$23.77
|
| Rate for Payer: Healthscope Whirlpool |
$24.50
|
| Rate for Payer: Mclaren Commercial |
$22.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.82
|
| Rate for Payer: Nomi Health Commercial |
$20.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21.47
|
| Rate for Payer: Priority Health Narrow Network |
$17.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.56
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$22.14
|
|
|
Service Code
|
NDC 69315030802
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$22.14 |
| Rate for Payer: Aetna Commercial |
$19.93
|
| Rate for Payer: Aetna Medicare |
$8.19
|
| Rate for Payer: ASR ASR |
$21.48
|
| Rate for Payer: BCBS Complete |
$8.86
|
| Rate for Payer: BCBS Trust/PPO |
$18.25
|
| Rate for Payer: BCN Commercial |
$18.25
|
| Rate for Payer: Cash Price |
$17.71
|
| Rate for Payer: Cofinity Commercial |
$20.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.71
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Healthscope Whirlpool |
$22.14
|
| Rate for Payer: Mclaren Commercial |
$19.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.82
|
| Rate for Payer: Nomi Health Commercial |
$18.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19.40
|
| Rate for Payer: Priority Health Narrow Network |
$15.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.48
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$24.50
|
|
|
Service Code
|
NDC 17478071425
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: ASR ASR |
$23.77
|
| Rate for Payer: BCBS Trust/PPO |
$20.12
|
| Rate for Payer: BCN Commercial |
$20.12
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Cofinity Commercial |
$23.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.60
|
| Rate for Payer: Healthscope Commercial |
$23.77
|
| Rate for Payer: Healthscope Whirlpool |
$24.50
|
| Rate for Payer: Mclaren Commercial |
$22.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.82
|
| Rate for Payer: Nomi Health Commercial |
$20.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.56
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$34.20
|
|
|
Service Code
|
NDC 61314065625
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna Commercial |
$30.78
|
| Rate for Payer: Aetna Medicare |
$12.65
|
| Rate for Payer: ASR ASR |
$33.17
|
| Rate for Payer: BCBS Complete |
$13.68
|
| Rate for Payer: BCBS Trust/PPO |
$28.19
|
| Rate for Payer: BCN Commercial |
$28.19
|
| Rate for Payer: Cash Price |
$27.36
|
| Rate for Payer: Cofinity Commercial |
$32.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.36
|
| Rate for Payer: Healthscope Commercial |
$33.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.20
|
| Rate for Payer: Mclaren Commercial |
$30.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.07
|
| Rate for Payer: Nomi Health Commercial |
$28.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29.96
|
| Rate for Payer: Priority Health Narrow Network |
$23.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.09
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$34.20
|
|
|
Service Code
|
NDC 61314065625
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna Commercial |
$30.78
|
| Rate for Payer: ASR ASR |
$33.17
|
| Rate for Payer: BCBS Trust/PPO |
$28.08
|
| Rate for Payer: BCN Commercial |
$28.08
|
| Rate for Payer: Cash Price |
$27.36
|
| Rate for Payer: Cofinity Commercial |
$32.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.36
|
| Rate for Payer: Healthscope Commercial |
$33.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.20
|
| Rate for Payer: Mclaren Commercial |
$30.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.07
|
| Rate for Payer: Nomi Health Commercial |
$28.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.09
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 143992801
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$343.69 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$412.43
|
| Rate for Payer: ASR ASR |
$444.50
|
| Rate for Payer: BCBS Trust/PPO |
$376.31
|
| Rate for Payer: BCN Commercial |
$376.31
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$430.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$444.50
|
| Rate for Payer: Healthscope Whirlpool |
$458.25
|
| Rate for Payer: Mclaren Commercial |
$412.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.26
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 143992801
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.55 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$412.43
|
| Rate for Payer: Aetna Medicare |
$169.55
|
| Rate for Payer: ASR ASR |
$444.50
|
| Rate for Payer: BCBS Complete |
$183.30
|
| Rate for Payer: BCBS Trust/PPO |
$377.83
|
| Rate for Payer: BCN Commercial |
$377.83
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$430.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$444.50
|
| Rate for Payer: Healthscope Whirlpool |
$458.25
|
| Rate for Payer: Mclaren Commercial |
$412.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$366.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$401.52
|
| Rate for Payer: Priority Health Narrow Network |
$321.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.26
|
|
|
CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$30,401.22
|
|
|
Service Code
|
MSDRG 286
|
| Min. Negotiated Rate |
$16,804.90 |
| Max. Negotiated Rate |
$30,401.22 |
| Rate for Payer: Aetna Medicare |
$17,689.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,111.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,111.71
|
| Rate for Payer: BCBS MAPPO |
$17,689.37
|
| Rate for Payer: BCN Medicare Advantage |
$17,689.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,689.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,689.37
|
| Rate for Payer: Mclaren Medicare |
$17,689.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,573.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,342.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,458.31
|
| Rate for Payer: PACE Medicare |
$16,804.90
|
| Rate for Payer: PACE SWMI |
$17,689.37
|
| Rate for Payer: PHP Commercial |
$19,458.31
|
| Rate for Payer: PHP Medicare Advantage |
$17,689.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30,401.22
|
| Rate for Payer: Priority Health Medicare |
$17,689.37
|
| Rate for Payer: Priority Health Narrow Network |
$24,320.97
|
| Rate for Payer: Railroad Medicare Medicare |
$17,689.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,689.37
|
| Rate for Payer: UHC Exchange |
$27,418.52
|
| Rate for Payer: UHCCP DNSP |
$17,689.37
|
| Rate for Payer: VA VA |
$17,689.37
|
|
|
CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
|
IP
|
$14,701.89
|
|
|
Service Code
|
MSDRG 287
|
| Min. Negotiated Rate |
$8,987.48 |
| Max. Negotiated Rate |
$14,701.89 |
| Rate for Payer: Aetna Medicare |
$9,460.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,825.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,825.64
|
| Rate for Payer: BCBS MAPPO |
$9,460.51
|
| Rate for Payer: BCN Medicare Advantage |
$9,460.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,460.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,460.51
|
| Rate for Payer: Mclaren Medicare |
$9,460.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,933.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,879.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,406.56
|
| Rate for Payer: PACE Medicare |
$8,987.48
|
| Rate for Payer: PACE SWMI |
$9,460.51
|
| Rate for Payer: PHP Commercial |
$10,406.56
|
| Rate for Payer: PHP Medicare Advantage |
$9,460.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,701.89
|
| Rate for Payer: Priority Health Medicare |
$9,460.51
|
| Rate for Payer: Priority Health Narrow Network |
$11,761.51
|
| Rate for Payer: Railroad Medicare Medicare |
$9,460.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,460.51
|
| Rate for Payer: UHC Exchange |
$14,663.79
|
| Rate for Payer: UHCCP DNSP |
$9,460.51
|
| Rate for Payer: VA VA |
$9,460.51
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC
|
Facility
|
IP
|
$14,510.92
|
|
|
Service Code
|
MSDRG 433
|
| Min. Negotiated Rate |
$8,892.39 |
| Max. Negotiated Rate |
$14,510.92 |
| Rate for Payer: Aetna Medicare |
$9,360.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,700.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,700.51
|
| Rate for Payer: BCBS MAPPO |
$9,360.41
|
| Rate for Payer: BCN Medicare Advantage |
$9,360.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,360.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,360.41
|
| Rate for Payer: Mclaren Medicare |
$9,360.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,828.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,764.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,296.45
|
| Rate for Payer: PACE Medicare |
$8,892.39
|
| Rate for Payer: PACE SWMI |
$9,360.41
|
| Rate for Payer: PHP Commercial |
$10,296.45
|
| Rate for Payer: PHP Medicare Advantage |
$9,360.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,510.92
|
| Rate for Payer: Priority Health Medicare |
$9,360.41
|
| Rate for Payer: Priority Health Narrow Network |
$11,608.74
|
| Rate for Payer: Railroad Medicare Medicare |
$9,360.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,360.41
|
| Rate for Payer: UHC Exchange |
$14,508.64
|
| Rate for Payer: UHCCP DNSP |
$9,360.41
|
| Rate for Payer: VA VA |
$9,360.41
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC
|
Facility
|
IP
|
$27,040.71
|
|
|
Service Code
|
MSDRG 432
|
| Min. Negotiated Rate |
$15,131.55 |
| Max. Negotiated Rate |
$27,040.71 |
| Rate for Payer: Aetna Medicare |
$15,927.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,909.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,909.94
|
| Rate for Payer: BCBS MAPPO |
$15,927.95
|
| Rate for Payer: BCN Medicare Advantage |
$15,927.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,927.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,927.95
|
| Rate for Payer: Mclaren Medicare |
$15,927.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,724.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,317.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,520.74
|
| Rate for Payer: PACE Medicare |
$15,131.55
|
| Rate for Payer: PACE SWMI |
$15,927.95
|
| Rate for Payer: PHP Commercial |
$17,520.74
|
| Rate for Payer: PHP Medicare Advantage |
$15,927.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27,040.71
|
| Rate for Payer: Priority Health Medicare |
$15,927.95
|
| Rate for Payer: Priority Health Narrow Network |
$21,632.56
|
| Rate for Payer: Railroad Medicare Medicare |
$15,927.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,927.95
|
| Rate for Payer: UHC Exchange |
$24,688.32
|
| Rate for Payer: UHCCP DNSP |
$15,927.95
|
| Rate for Payer: VA VA |
$15,927.95
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$10,672.29
|
|
|
Service Code
|
MSDRG 434
|
| Min. Negotiated Rate |
$6,541.08 |
| Max. Negotiated Rate |
$10,672.29 |
| Rate for Payer: Aetna Medicare |
$6,885.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,606.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,606.69
|
| Rate for Payer: BCBS MAPPO |
$6,885.35
|
| Rate for Payer: BCN Medicare Advantage |
$6,885.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,885.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,885.35
|
| Rate for Payer: Mclaren Medicare |
$6,885.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,229.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,918.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,573.89
|
| Rate for Payer: PACE Medicare |
$6,541.08
|
| Rate for Payer: PACE SWMI |
$6,885.35
|
| Rate for Payer: PHP Commercial |
$7,573.89
|
| Rate for Payer: PHP Medicare Advantage |
$6,885.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9,788.90
|
| Rate for Payer: Priority Health Medicare |
$6,885.35
|
| Rate for Payer: Priority Health Narrow Network |
$7,831.12
|
| Rate for Payer: Railroad Medicare Medicare |
$6,885.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,885.35
|
| Rate for Payer: UHC Exchange |
$10,672.29
|
| Rate for Payer: UHCCP DNSP |
$6,885.35
|
| Rate for Payer: VA VA |
$6,885.35
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$14.34
|
|
|
Service Code
|
NDC 904608561
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$14.34 |
| Rate for Payer: Aetna Commercial |
$12.90
|
| Rate for Payer: ASR ASR |
$13.90
|
| Rate for Payer: BCBS Trust/PPO |
$11.77
|
| Rate for Payer: BCN Commercial |
$11.77
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$13.90
|
| Rate for Payer: Healthscope Whirlpool |
$14.34
|
| Rate for Payer: Mclaren Commercial |
$12.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.18
|
| Rate for Payer: Nomi Health Commercial |
$11.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.61
|
|
|
CITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$14.34
|
|
|
Service Code
|
NDC 904608561
|
| Hospital Charge Code |
21062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$14.34 |
| Rate for Payer: Aetna Commercial |
$12.90
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: ASR ASR |
$13.90
|
| Rate for Payer: BCBS Complete |
$5.73
|
| Rate for Payer: BCBS Trust/PPO |
$11.82
|
| Rate for Payer: BCN Commercial |
$11.82
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$13.90
|
| Rate for Payer: Healthscope Whirlpool |
$14.34
|
| Rate for Payer: Mclaren Commercial |
$12.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.18
|
| Rate for Payer: Nomi Health Commercial |
$11.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12.56
|
| Rate for Payer: Priority Health Narrow Network |
$10.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.61
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
|
IP
|
$7,705.59
|
|
|
Service Code
|
APR-DRG 0951
|
| Min. Negotiated Rate |
$6,966.78 |
| Max. Negotiated Rate |
$7,705.59 |
| Rate for Payer: BCBS Complete |
$7,705.59
|
| Rate for Payer: Mclaren Medicaid |
$7,338.66
|
| Rate for Payer: Meridian Medicaid |
$7,705.59
|
| Rate for Payer: PHP Medicaid |
$6,966.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,338.66
|
| Rate for Payer: UHC Medicaid |
$7,338.66
|
| Rate for Payer: UHCCP Medicaid |
$7,338.66
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
|
IP
|
$10,344.79
|
|
|
Service Code
|
APR-DRG 0952
|
| Min. Negotiated Rate |
$9,352.92 |
| Max. Negotiated Rate |
$10,344.79 |
| Rate for Payer: BCBS Complete |
$10,344.79
|
| Rate for Payer: Mclaren Medicaid |
$9,852.18
|
| Rate for Payer: Meridian Medicaid |
$10,344.79
|
| Rate for Payer: PHP Medicaid |
$9,352.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,852.18
|
| Rate for Payer: UHC Medicaid |
$9,852.18
|
| Rate for Payer: UHCCP Medicaid |
$9,852.18
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
|
IP
|
$12,255.38
|
|
|
Service Code
|
APR-DRG 0953
|
| Min. Negotiated Rate |
$11,080.33 |
| Max. Negotiated Rate |
$12,255.38 |
| Rate for Payer: BCBS Complete |
$12,255.38
|
| Rate for Payer: Mclaren Medicaid |
$11,671.79
|
| Rate for Payer: Meridian Medicaid |
$12,255.38
|
| Rate for Payer: PHP Medicaid |
$11,080.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,671.79
|
| Rate for Payer: UHC Medicaid |
$11,671.79
|
| Rate for Payer: UHCCP Medicaid |
$11,671.79
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
|
IP
|
$21,457.41
|
|
|
Service Code
|
APR-DRG 0954
|
| Min. Negotiated Rate |
$19,400.06 |
| Max. Negotiated Rate |
$21,457.41 |
| Rate for Payer: BCBS Complete |
$21,457.41
|
| Rate for Payer: Mclaren Medicaid |
$20,435.62
|
| Rate for Payer: Meridian Medicaid |
$21,457.41
|
| Rate for Payer: PHP Medicaid |
$19,400.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,435.62
|
| Rate for Payer: UHC Medicaid |
$20,435.62
|
| Rate for Payer: UHCCP Medicaid |
$20,435.62
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$24.05
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.04 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Commercial |
$19.83
|
| Rate for Payer: ASR ASR |
$21.37
|
| Rate for Payer: ASR ASR |
$23.33
|
| Rate for Payer: BCBS Trust/PPO |
$18.09
|
| Rate for Payer: BCBS Trust/PPO |
$19.75
|
| Rate for Payer: BCN Commercial |
$18.09
|
| Rate for Payer: BCN Commercial |
$19.75
|
| Rate for Payer: Cash Price |
$17.62
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$22.61
|
| Rate for Payer: Cofinity Commercial |
$20.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$23.33
|
| Rate for Payer: Healthscope Commercial |
$21.37
|
| Rate for Payer: Healthscope Whirlpool |
$22.03
|
| Rate for Payer: Healthscope Whirlpool |
$24.05
|
| Rate for Payer: Mclaren Commercial |
$19.83
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Nomi Health Commercial |
$18.06
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.38
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$24.05
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Commercial |
$19.83
|
| Rate for Payer: Aetna Medicare |
$8.15
|
| Rate for Payer: Aetna Medicare |
$8.90
|
| Rate for Payer: ASR ASR |
$23.33
|
| Rate for Payer: ASR ASR |
$21.37
|
| Rate for Payer: BCBS Complete |
$8.81
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$18.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.83
|
| Rate for Payer: BCN Commercial |
$18.16
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: Cash Price |
$17.62
|
| Rate for Payer: Cash Price |
$17.62
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$20.71
|
| Rate for Payer: Cofinity Commercial |
$22.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$21.37
|
| Rate for Payer: Healthscope Commercial |
$23.33
|
| Rate for Payer: Healthscope Whirlpool |
$24.05
|
| Rate for Payer: Healthscope Whirlpool |
$22.03
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: Mclaren Commercial |
$19.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Nomi Health Commercial |
$18.06
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.99
|
| Rate for Payer: Priority Health Narrow Network |
$1.59
|
| Rate for Payer: Priority Health Narrow Network |
$1.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.38
|
|
|
CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
IP
|
$24.05
|
|
|
Service Code
|
NDC 143926801
|
| Hospital Charge Code |
300021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.04 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: ASR ASR |
$23.33
|
| Rate for Payer: BCBS Trust/PPO |
$19.75
|
| Rate for Payer: BCN Commercial |
$19.75
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$22.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$23.33
|
| Rate for Payer: Healthscope Whirlpool |
$24.05
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
|
|
CLINDAMYCIN 600 MG/50 ML IVPB IN D5W OR NS CUSTOM
|
Facility
|
OP
|
$24.05
|
|
|
Service Code
|
NDC 143926801
|
| Hospital Charge Code |
300021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Medicare |
$8.90
|
| Rate for Payer: ASR ASR |
$23.33
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$19.83
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$22.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$23.33
|
| Rate for Payer: Healthscope Whirlpool |
$24.05
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21.07
|
| Rate for Payer: Priority Health Narrow Network |
$16.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
|
