|
MS-DRG 42.00: VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$15,278.72
|
|
|
Service Code
|
MSDRG 076
|
| Min. Negotiated Rate |
$9,364.38 |
| Max. Negotiated Rate |
$15,278.72 |
| Rate for Payer: Aetna Medicare |
$9,857.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,321.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,321.55
|
| Rate for Payer: BCBS MAPPO |
$9,857.24
|
| Rate for Payer: BCN Medicare Advantage |
$9,857.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,857.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,857.24
|
| Rate for Payer: Mclaren Medicare |
$9,857.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,350.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,335.83
|
| Rate for Payer: PACE Medicare |
$9,364.38
|
| Rate for Payer: PACE SWMI |
$9,857.24
|
| Rate for Payer: PHP Commercial |
$10,842.96
|
| Rate for Payer: PHP Medicare Advantage |
$9,857.24
|
| Rate for Payer: Priority Health Medicare |
$9,857.24
|
| Rate for Payer: Railroad Medicare Medicare |
$9,857.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,857.24
|
| Rate for Payer: UHC Exchange |
$15,278.72
|
| Rate for Payer: UHC Medicare Advantage |
$9,857.24
|
| Rate for Payer: UHCCP DNSP |
$9,857.24
|
| Rate for Payer: VA VA |
$9,857.24
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$43,378.83
|
|
|
Service Code
|
MSDRG 464
|
| Min. Negotiated Rate |
$26,587.02 |
| Max. Negotiated Rate |
$43,378.83 |
| Rate for Payer: Aetna Medicare |
$27,986.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,982.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,982.93
|
| Rate for Payer: BCBS MAPPO |
$27,986.34
|
| Rate for Payer: BCN Medicare Advantage |
$27,986.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,986.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$27,986.34
|
| Rate for Payer: Mclaren Medicare |
$27,986.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,385.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,184.29
|
| Rate for Payer: PACE Medicare |
$26,587.02
|
| Rate for Payer: PACE SWMI |
$27,986.34
|
| Rate for Payer: PHP Commercial |
$30,784.97
|
| Rate for Payer: PHP Medicare Advantage |
$27,986.34
|
| Rate for Payer: Priority Health Medicare |
$27,986.34
|
| Rate for Payer: Railroad Medicare Medicare |
$27,986.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$27,986.34
|
| Rate for Payer: UHC Exchange |
$43,378.83
|
| Rate for Payer: UHC Medicare Advantage |
$27,986.34
|
| Rate for Payer: UHCCP DNSP |
$27,986.34
|
| Rate for Payer: VA VA |
$27,986.34
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$77,297.57
|
|
|
Service Code
|
MSDRG 463
|
| Min. Negotiated Rate |
$47,375.93 |
| Max. Negotiated Rate |
$77,297.57 |
| Rate for Payer: Aetna Medicare |
$49,869.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62,336.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62,336.75
|
| Rate for Payer: BCBS MAPPO |
$49,869.40
|
| Rate for Payer: BCN Medicare Advantage |
$49,869.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49,869.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$49,869.40
|
| Rate for Payer: Mclaren Medicare |
$49,869.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52,362.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57,349.81
|
| Rate for Payer: PACE Medicare |
$47,375.93
|
| Rate for Payer: PACE SWMI |
$49,869.40
|
| Rate for Payer: PHP Commercial |
$54,856.34
|
| Rate for Payer: PHP Medicare Advantage |
$49,869.40
|
| Rate for Payer: Priority Health Medicare |
$49,869.40
|
| Rate for Payer: Railroad Medicare Medicare |
$49,869.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$49,869.40
|
| Rate for Payer: UHC Exchange |
$77,297.57
|
| Rate for Payer: UHC Medicare Advantage |
$49,869.40
|
| Rate for Payer: UHCCP DNSP |
$49,869.40
|
| Rate for Payer: VA VA |
$49,869.40
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$26,608.93
|
|
|
Service Code
|
MSDRG 465
|
| Min. Negotiated Rate |
$16,308.70 |
| Max. Negotiated Rate |
$26,608.93 |
| Rate for Payer: Aetna Medicare |
$17,167.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,458.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,458.81
|
| Rate for Payer: BCBS MAPPO |
$17,167.05
|
| Rate for Payer: BCN Medicare Advantage |
$17,167.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,167.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,167.05
|
| Rate for Payer: Mclaren Medicare |
$17,167.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,025.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,742.11
|
| Rate for Payer: PACE Medicare |
$16,308.70
|
| Rate for Payer: PACE SWMI |
$17,167.05
|
| Rate for Payer: PHP Commercial |
$18,883.76
|
| Rate for Payer: PHP Medicare Advantage |
$17,167.05
|
| Rate for Payer: Priority Health Medicare |
$17,167.05
|
| Rate for Payer: Railroad Medicare Medicare |
$17,167.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,167.05
|
| Rate for Payer: UHC Exchange |
$26,608.93
|
| Rate for Payer: UHC Medicare Advantage |
$17,167.05
|
| Rate for Payer: UHCCP DNSP |
$17,167.05
|
| Rate for Payer: VA VA |
$17,167.05
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
|
IP
|
$28,842.62
|
|
|
Service Code
|
MSDRG 902
|
| Min. Negotiated Rate |
$17,677.73 |
| Max. Negotiated Rate |
$28,842.62 |
| Rate for Payer: Aetna Medicare |
$18,608.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,260.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,260.17
|
| Rate for Payer: BCBS MAPPO |
$18,608.14
|
| Rate for Payer: BCN Medicare Advantage |
$18,608.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,608.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,608.14
|
| Rate for Payer: Mclaren Medicare |
$18,608.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,538.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,399.36
|
| Rate for Payer: PACE Medicare |
$17,677.73
|
| Rate for Payer: PACE SWMI |
$18,608.14
|
| Rate for Payer: PHP Commercial |
$20,468.95
|
| Rate for Payer: PHP Medicare Advantage |
$18,608.14
|
| Rate for Payer: Priority Health Medicare |
$18,608.14
|
| Rate for Payer: Railroad Medicare Medicare |
$18,608.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$18,608.14
|
| Rate for Payer: UHC Exchange |
$28,842.62
|
| Rate for Payer: UHC Medicare Advantage |
$18,608.14
|
| Rate for Payer: UHCCP DNSP |
$18,608.14
|
| Rate for Payer: VA VA |
$18,608.14
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
|
IP
|
$63,874.72
|
|
|
Service Code
|
MSDRG 901
|
| Min. Negotiated Rate |
$39,149.03 |
| Max. Negotiated Rate |
$63,874.72 |
| Rate for Payer: Aetna Medicare |
$41,209.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51,511.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51,511.88
|
| Rate for Payer: BCBS MAPPO |
$41,209.50
|
| Rate for Payer: BCN Medicare Advantage |
$41,209.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41,209.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$41,209.50
|
| Rate for Payer: Mclaren Medicare |
$41,209.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43,269.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47,390.93
|
| Rate for Payer: PACE Medicare |
$39,149.03
|
| Rate for Payer: PACE SWMI |
$41,209.50
|
| Rate for Payer: PHP Commercial |
$45,330.45
|
| Rate for Payer: PHP Medicare Advantage |
$41,209.50
|
| Rate for Payer: Priority Health Medicare |
$41,209.50
|
| Rate for Payer: Railroad Medicare Medicare |
$41,209.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$41,209.50
|
| Rate for Payer: UHC Exchange |
$63,874.72
|
| Rate for Payer: UHC Medicare Advantage |
$41,209.50
|
| Rate for Payer: UHCCP DNSP |
$41,209.50
|
| Rate for Payer: VA VA |
$41,209.50
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$19,458.39
|
|
|
Service Code
|
MSDRG 903
|
| Min. Negotiated Rate |
$11,926.11 |
| Max. Negotiated Rate |
$19,458.39 |
| Rate for Payer: Aetna Medicare |
$12,553.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,692.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,692.25
|
| Rate for Payer: BCBS MAPPO |
$12,553.80
|
| Rate for Payer: BCN Medicare Advantage |
$12,553.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,553.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,553.80
|
| Rate for Payer: Mclaren Medicare |
$12,553.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,181.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,436.87
|
| Rate for Payer: PACE Medicare |
$11,926.11
|
| Rate for Payer: PACE SWMI |
$12,553.80
|
| Rate for Payer: PHP Commercial |
$13,809.18
|
| Rate for Payer: PHP Medicare Advantage |
$12,553.80
|
| Rate for Payer: Priority Health Medicare |
$12,553.80
|
| Rate for Payer: Railroad Medicare Medicare |
$12,553.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,553.80
|
| Rate for Payer: UHC Exchange |
$19,458.39
|
| Rate for Payer: UHC Medicare Advantage |
$12,553.80
|
| Rate for Payer: UHCCP DNSP |
$12,553.80
|
| Rate for Payer: VA VA |
$12,553.80
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
NDC 00904549261
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Aetna Medicare |
$90.00
|
| Rate for Payer: ASR ASR |
$174.60
|
| Rate for Payer: ASR Commercial |
$174.60
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS Trust/PPO |
$147.40
|
| Rate for Payer: BCN Commercial |
$139.55
|
| 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 |
$180.00
|
| Rate for Payer: Healthscope Whirlpool |
$174.60
|
| 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: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: 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
|
$2.06
|
|
|
Service Code
|
NDC 77333086125
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: Aetna Commercial |
$1.85
|
| Rate for Payer: ASR ASR |
$2.00
|
| Rate for Payer: ASR Commercial |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.68
|
| Rate for Payer: BCN Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.65
|
| Rate for Payer: Healthscope Commercial |
$2.06
|
| Rate for Payer: Healthscope Whirlpool |
$2.00
|
| Rate for Payer: Mclaren Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.75
|
| Rate for Payer: Nomi Health Commercial |
$1.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.81
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$205.70
|
|
|
Service Code
|
NDC 77333086110
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.28 |
| Max. Negotiated Rate |
$205.70 |
| Rate for Payer: Aetna Commercial |
$185.13
|
| Rate for Payer: Aetna Medicare |
$102.85
|
| Rate for Payer: ASR ASR |
$199.53
|
| Rate for Payer: ASR Commercial |
$199.53
|
| Rate for Payer: BCBS Complete |
$82.28
|
| Rate for Payer: BCBS Trust/PPO |
$168.45
|
| Rate for Payer: BCN Commercial |
$159.48
|
| Rate for Payer: Cash Price |
$164.56
|
| Rate for Payer: Cofinity Commercial |
$193.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.56
|
| Rate for Payer: Healthscope Commercial |
$205.70
|
| Rate for Payer: Healthscope Whirlpool |
$199.53
|
| Rate for Payer: Mclaren Commercial |
$185.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.84
|
| Rate for Payer: Nomi Health Commercial |
$168.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.23
|
| Rate for Payer: Priority Health Narrow Network |
$144.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.02
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$275.60
|
|
|
Service Code
|
NDC 40985022368
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.24 |
| Max. Negotiated Rate |
$275.60 |
| Rate for Payer: Aetna Commercial |
$248.04
|
| Rate for Payer: Aetna Medicare |
$137.80
|
| Rate for Payer: ASR ASR |
$267.33
|
| Rate for Payer: ASR Commercial |
$267.33
|
| Rate for Payer: BCBS Complete |
$110.24
|
| Rate for Payer: BCBS Trust/PPO |
$225.69
|
| Rate for Payer: BCN Commercial |
$213.67
|
| Rate for Payer: Cash Price |
$220.48
|
| Rate for Payer: Cofinity Commercial |
$259.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.48
|
| Rate for Payer: Healthscope Commercial |
$275.60
|
| Rate for Payer: Healthscope Whirlpool |
$267.33
|
| Rate for Payer: Mclaren Commercial |
$248.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.26
|
| Rate for Payer: Nomi Health Commercial |
$225.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.48
|
| Rate for Payer: Priority Health Narrow Network |
$193.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.53
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$2.06
|
|
|
Service Code
|
NDC 77333086125
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: Aetna Commercial |
$1.85
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: ASR ASR |
$2.00
|
| Rate for Payer: ASR Commercial |
$2.00
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.65
|
| Rate for Payer: Healthscope Commercial |
$2.06
|
| Rate for Payer: Healthscope Whirlpool |
$2.00
|
| Rate for Payer: Mclaren Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.75
|
| Rate for Payer: Nomi Health Commercial |
$1.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.80
|
| Rate for Payer: Priority Health Narrow Network |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.81
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$275.60
|
|
|
Service Code
|
NDC 40985022368
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.14 |
| Max. Negotiated Rate |
$275.60 |
| Rate for Payer: Aetna Commercial |
$248.04
|
| Rate for Payer: ASR ASR |
$267.33
|
| Rate for Payer: ASR Commercial |
$267.33
|
| Rate for Payer: BCBS Trust/PPO |
$224.59
|
| Rate for Payer: BCN Commercial |
$213.67
|
| Rate for Payer: Cash Price |
$220.48
|
| Rate for Payer: Cofinity Commercial |
$259.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.48
|
| Rate for Payer: Healthscope Commercial |
$275.60
|
| Rate for Payer: Healthscope Whirlpool |
$267.33
|
| Rate for Payer: Mclaren Commercial |
$248.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.26
|
| Rate for Payer: Nomi Health Commercial |
$225.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.53
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$205.70
|
|
|
Service Code
|
NDC 77333086110
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.71 |
| Max. Negotiated Rate |
$205.70 |
| Rate for Payer: Aetna Commercial |
$185.13
|
| Rate for Payer: ASR ASR |
$199.53
|
| Rate for Payer: ASR Commercial |
$199.53
|
| Rate for Payer: BCBS Trust/PPO |
$167.62
|
| Rate for Payer: BCN Commercial |
$159.48
|
| Rate for Payer: Cash Price |
$164.56
|
| Rate for Payer: Cofinity Commercial |
$193.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.56
|
| Rate for Payer: Healthscope Commercial |
$205.70
|
| Rate for Payer: Healthscope Whirlpool |
$199.53
|
| Rate for Payer: Mclaren Commercial |
$185.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.84
|
| Rate for Payer: Nomi Health Commercial |
$168.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.02
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
NDC 00904549261
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: ASR ASR |
$174.60
|
| Rate for Payer: ASR Commercial |
$174.60
|
| Rate for Payer: BCBS Trust/PPO |
$146.68
|
| Rate for Payer: BCN Commercial |
$139.55
|
| 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 |
$180.00
|
| Rate for Payer: Healthscope Whirlpool |
$174.60
|
| 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: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.40
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$20.79
|
|
|
Service Code
|
NDC 51672131200
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$20.79 |
| Rate for Payer: Aetna Commercial |
$18.71
|
| Rate for Payer: Aetna Medicare |
$10.39
|
| Rate for Payer: ASR ASR |
$20.17
|
| Rate for Payer: ASR Commercial |
$20.17
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$17.02
|
| Rate for Payer: BCN Commercial |
$16.12
|
| 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 |
$20.79
|
| Rate for Payer: Healthscope Whirlpool |
$20.17
|
| 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: Priority Health Cigna Priority Health |
$13.51
|
| Rate for Payer: 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 |
$13.51 |
| Max. Negotiated Rate |
$20.79 |
| Rate for Payer: Aetna Commercial |
$18.71
|
| Rate for Payer: ASR ASR |
$20.17
|
| Rate for Payer: ASR Commercial |
$20.17
|
| Rate for Payer: BCBS Trust/PPO |
$16.94
|
| Rate for Payer: BCN Commercial |
$16.12
|
| 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 |
$20.79
|
| Rate for Payer: Healthscope Whirlpool |
$20.17
|
| 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: Priority Health Cigna Priority Health |
$13.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.30
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$29.95
|
|
|
Service Code
|
NDC 68462018022
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$29.95 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: ASR ASR |
$29.05
|
| Rate for Payer: ASR Commercial |
$29.05
|
| Rate for Payer: BCBS Trust/PPO |
$24.41
|
| Rate for Payer: BCN Commercial |
$23.22
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cofinity Commercial |
$28.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.96
|
| Rate for Payer: Healthscope Commercial |
$29.95
|
| Rate for Payer: Healthscope Whirlpool |
$29.05
|
| Rate for Payer: Mclaren Commercial |
$26.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.46
|
| Rate for Payer: Nomi Health Commercial |
$24.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.36
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$29.95
|
|
|
Service Code
|
NDC 45802011222
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$29.95 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: ASR ASR |
$29.05
|
| Rate for Payer: ASR Commercial |
$29.05
|
| Rate for Payer: BCBS Complete |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$24.53
|
| Rate for Payer: BCN Commercial |
$23.22
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cofinity Commercial |
$28.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.96
|
| Rate for Payer: Healthscope Commercial |
$29.95
|
| Rate for Payer: Healthscope Whirlpool |
$29.05
|
| Rate for Payer: Mclaren Commercial |
$26.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.46
|
| Rate for Payer: Nomi Health Commercial |
$24.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.24
|
| Rate for Payer: Priority Health Narrow Network |
$20.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.36
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$29.95
|
|
|
Service Code
|
NDC 45802011222
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$29.95 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: ASR ASR |
$29.05
|
| Rate for Payer: ASR Commercial |
$29.05
|
| Rate for Payer: BCBS Trust/PPO |
$24.41
|
| Rate for Payer: BCN Commercial |
$23.22
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cofinity Commercial |
$28.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.96
|
| Rate for Payer: Healthscope Commercial |
$29.95
|
| Rate for Payer: Healthscope Whirlpool |
$29.05
|
| Rate for Payer: Mclaren Commercial |
$26.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.46
|
| Rate for Payer: Nomi Health Commercial |
$24.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.36
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$29.95
|
|
|
Service Code
|
NDC 68462018022
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$29.95 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: ASR ASR |
$29.05
|
| Rate for Payer: ASR Commercial |
$29.05
|
| Rate for Payer: BCBS Complete |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$24.53
|
| Rate for Payer: BCN Commercial |
$23.22
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cofinity Commercial |
$28.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.96
|
| Rate for Payer: Healthscope Commercial |
$29.95
|
| Rate for Payer: Healthscope Whirlpool |
$29.05
|
| Rate for Payer: Mclaren Commercial |
$26.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.46
|
| Rate for Payer: Nomi Health Commercial |
$24.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.24
|
| Rate for Payer: Priority Health Narrow Network |
$20.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.36
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE
|
Facility
|
IP
|
$432.40
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
15113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$281.06 |
| Max. Negotiated Rate |
$432.40 |
| Rate for Payer: Aetna Commercial |
$389.16
|
| Rate for Payer: Aetna Commercial |
$1,226.70
|
| Rate for Payer: ASR ASR |
$1,322.11
|
| Rate for Payer: ASR ASR |
$419.43
|
| Rate for Payer: ASR Commercial |
$1,322.11
|
| Rate for Payer: ASR Commercial |
$419.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,110.71
|
| Rate for Payer: BCBS Trust/PPO |
$352.36
|
| Rate for Payer: BCN Commercial |
$335.24
|
| Rate for Payer: BCN Commercial |
$1,056.73
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cofinity Commercial |
$1,281.22
|
| Rate for Payer: Cofinity Commercial |
$406.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,090.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$1,363.00
|
| Rate for Payer: Healthscope Commercial |
$432.40
|
| Rate for Payer: Healthscope Whirlpool |
$419.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,322.11
|
| Rate for Payer: Mclaren Commercial |
$1,226.70
|
| Rate for Payer: Mclaren Commercial |
$389.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,158.55
|
| Rate for Payer: Nomi Health Commercial |
$354.57
|
| Rate for Payer: Nomi Health Commercial |
$1,117.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,199.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$380.51
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE
|
Facility
|
OP
|
$1,363.00
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
15113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$545.20 |
| Max. Negotiated Rate |
$1,363.00 |
| Rate for Payer: Aetna Commercial |
$1,226.70
|
| Rate for Payer: Aetna Commercial |
$389.16
|
| Rate for Payer: Aetna Medicare |
$681.50
|
| Rate for Payer: Aetna Medicare |
$216.20
|
| Rate for Payer: ASR ASR |
$1,322.11
|
| Rate for Payer: ASR ASR |
$419.43
|
| Rate for Payer: ASR Commercial |
$419.43
|
| Rate for Payer: ASR Commercial |
$1,322.11
|
| Rate for Payer: BCBS Complete |
$545.20
|
| Rate for Payer: BCBS Complete |
$172.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,116.16
|
| Rate for Payer: BCBS Trust/PPO |
$354.09
|
| Rate for Payer: BCN Commercial |
$335.24
|
| Rate for Payer: BCN Commercial |
$1,056.73
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Commercial |
$1,281.22
|
| Rate for Payer: Cofinity Commercial |
$406.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,090.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$1,363.00
|
| Rate for Payer: Healthscope Commercial |
$432.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,322.11
|
| Rate for Payer: Healthscope Whirlpool |
$419.43
|
| Rate for Payer: Mclaren Commercial |
$1,226.70
|
| Rate for Payer: Mclaren Commercial |
$389.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,158.55
|
| Rate for Payer: Nomi Health Commercial |
$1,117.66
|
| Rate for Payer: Nomi Health Commercial |
$354.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,194.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$378.87
|
| Rate for Payer: Priority Health Narrow Network |
$303.11
|
| Rate for Payer: Priority Health Narrow Network |
$955.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$380.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,199.44
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
IP
|
$359.97
|
|
|
Service Code
|
NDC 60687031325
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.98 |
| Max. Negotiated Rate |
$359.97 |
| Rate for Payer: Aetna Commercial |
$323.97
|
| Rate for Payer: ASR ASR |
$349.17
|
| Rate for Payer: ASR Commercial |
$349.17
|
| Rate for Payer: BCBS Trust/PPO |
$293.34
|
| Rate for Payer: BCN Commercial |
$279.08
|
| Rate for Payer: Cash Price |
$287.98
|
| Rate for Payer: Cofinity Commercial |
$338.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.98
|
| Rate for Payer: Healthscope Commercial |
$359.97
|
| Rate for Payer: Healthscope Whirlpool |
$349.17
|
| Rate for Payer: Mclaren Commercial |
$323.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.97
|
| Rate for Payer: Nomi Health Commercial |
$295.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.77
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
NDC 69238112409
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Aetna Medicare |
$141.50
|
| Rate for Payer: ASR ASR |
$274.51
|
| Rate for Payer: ASR Commercial |
$274.51
|
| Rate for Payer: BCBS Complete |
$113.20
|
| Rate for Payer: BCBS Trust/PPO |
$231.75
|
| Rate for Payer: BCN Commercial |
$219.41
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cofinity Commercial |
$266.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.40
|
| Rate for Payer: Healthscope Commercial |
$283.00
|
| Rate for Payer: Healthscope Whirlpool |
$274.51
|
| Rate for Payer: Mclaren Commercial |
$254.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.55
|
| Rate for Payer: Nomi Health Commercial |
$232.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.96
|
| Rate for Payer: Priority Health Narrow Network |
$198.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.04
|
|
