|
APR-DRG 42.00: VIRAL MENINGITIS
|
Facility
|
IP
|
$4,552.55
|
|
|
Service Code
|
APR-DRG 0512
|
| Min. Negotiated Rate |
$4,335.76 |
| Max. Negotiated Rate |
$4,552.55 |
| Rate for Payer: BCBS Complete |
$4,552.55
|
| Rate for Payer: Mclaren Medicaid |
$4,335.76
|
| Rate for Payer: Meridian Medicaid |
$4,552.55
|
| Rate for Payer: PHP Medicaid |
$4,335.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,335.76
|
| Rate for Payer: UHCCP Medicaid |
$4,335.76
|
|
|
APR-DRG 42.00: VIRAL MENINGITIS
|
Facility
|
IP
|
$7,139.22
|
|
|
Service Code
|
APR-DRG 0513
|
| Min. Negotiated Rate |
$6,799.26 |
| Max. Negotiated Rate |
$7,139.22 |
| Rate for Payer: BCBS Complete |
$7,139.22
|
| Rate for Payer: Mclaren Medicaid |
$6,799.26
|
| Rate for Payer: Meridian Medicaid |
$7,139.22
|
| Rate for Payer: PHP Medicaid |
$6,799.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,799.26
|
| Rate for Payer: UHCCP Medicaid |
$6,799.26
|
|
|
ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$311.51
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
28947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$311.51 |
| Rate for Payer: Aetna Commercial |
$280.36
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.00
|
| Rate for Payer: ASR ASR |
$302.16
|
| Rate for Payer: ASR Commercial |
$302.16
|
| Rate for Payer: BCBS Complete |
$0.45
|
| Rate for Payer: BCBS MAPPO |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$255.10
|
| Rate for Payer: BCN Commercial |
$241.51
|
| Rate for Payer: BCN Medicare Advantage |
$0.80
|
| Rate for Payer: Cash Price |
$249.21
|
| Rate for Payer: Cash Price |
$249.21
|
| Rate for Payer: Cofinity Commercial |
$292.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.80
|
| Rate for Payer: Healthscope Commercial |
$311.51
|
| Rate for Payer: Healthscope Whirlpool |
$302.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.80
|
| Rate for Payer: Mclaren Commercial |
$280.36
|
| Rate for Payer: Mclaren Medicaid |
$0.43
|
| Rate for Payer: Mclaren Medicare |
$0.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.84
|
| Rate for Payer: Meridian Medicaid |
$0.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.78
|
| Rate for Payer: Nomi Health Commercial |
$255.44
|
| Rate for Payer: PACE Medicare |
$0.76
|
| Rate for Payer: PACE SWMI |
$0.80
|
| Rate for Payer: PHP Commercial |
$0.88
|
| Rate for Payer: PHP Medicaid |
$0.43
|
| Rate for Payer: PHP Medicare Advantage |
$0.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.95
|
| Rate for Payer: Priority Health Medicare |
$0.80
|
| Rate for Payer: Priority Health Narrow Network |
$218.37
|
| Rate for Payer: Railroad Medicare Medicare |
$0.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.80
|
| Rate for Payer: UHC Exchange |
$1.24
|
| Rate for Payer: UHC Medicare Advantage |
$0.80
|
| Rate for Payer: UHCCP DNSP |
$0.80
|
| Rate for Payer: UHCCP Medicaid |
$0.43
|
| Rate for Payer: VA VA |
$0.80
|
|
|
ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$311.51
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
28947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$202.48 |
| Max. Negotiated Rate |
$311.51 |
| Rate for Payer: Aetna Commercial |
$280.36
|
| Rate for Payer: ASR ASR |
$302.16
|
| Rate for Payer: ASR Commercial |
$302.16
|
| Rate for Payer: BCBS Trust/PPO |
$253.85
|
| Rate for Payer: BCN Commercial |
$241.51
|
| Rate for Payer: Cash Price |
$249.21
|
| Rate for Payer: Cofinity Commercial |
$292.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.21
|
| Rate for Payer: Healthscope Commercial |
$311.51
|
| Rate for Payer: Healthscope Whirlpool |
$302.16
|
| Rate for Payer: Mclaren Commercial |
$280.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.78
|
| Rate for Payer: Nomi Health Commercial |
$255.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.13
|
|
|
ARGATROBAN 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$333.15
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
152708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$216.55 |
| Max. Negotiated Rate |
$333.15 |
| Rate for Payer: Aetna Commercial |
$299.83
|
| Rate for Payer: ASR ASR |
$323.16
|
| Rate for Payer: ASR Commercial |
$323.16
|
| Rate for Payer: BCBS Trust/PPO |
$271.48
|
| Rate for Payer: BCN Commercial |
$258.29
|
| Rate for Payer: Cash Price |
$266.52
|
| Rate for Payer: Cofinity Commercial |
$313.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.52
|
| Rate for Payer: Healthscope Commercial |
$333.15
|
| Rate for Payer: Healthscope Whirlpool |
$323.16
|
| Rate for Payer: Mclaren Commercial |
$299.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.18
|
| Rate for Payer: Nomi Health Commercial |
$273.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.17
|
|
|
ARGATROBAN 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$333.15
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
152708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$333.15 |
| Rate for Payer: Aetna Commercial |
$299.83
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.00
|
| Rate for Payer: ASR ASR |
$323.16
|
| Rate for Payer: ASR Commercial |
$323.16
|
| Rate for Payer: BCBS Complete |
$0.45
|
| Rate for Payer: BCBS MAPPO |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$272.82
|
| Rate for Payer: BCN Commercial |
$258.29
|
| Rate for Payer: BCN Medicare Advantage |
$0.80
|
| Rate for Payer: Cash Price |
$266.52
|
| Rate for Payer: Cash Price |
$266.52
|
| Rate for Payer: Cofinity Commercial |
$313.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.80
|
| Rate for Payer: Healthscope Commercial |
$333.15
|
| Rate for Payer: Healthscope Whirlpool |
$323.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.80
|
| Rate for Payer: Mclaren Commercial |
$299.83
|
| Rate for Payer: Mclaren Medicaid |
$0.43
|
| Rate for Payer: Mclaren Medicare |
$0.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.84
|
| Rate for Payer: Meridian Medicaid |
$0.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.18
|
| Rate for Payer: Nomi Health Commercial |
$273.18
|
| Rate for Payer: PACE Medicare |
$0.76
|
| Rate for Payer: PACE SWMI |
$0.80
|
| Rate for Payer: PHP Commercial |
$0.88
|
| Rate for Payer: PHP Medicaid |
$0.43
|
| Rate for Payer: PHP Medicare Advantage |
$0.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$291.91
|
| Rate for Payer: Priority Health Medicare |
$0.80
|
| Rate for Payer: Priority Health Narrow Network |
$233.54
|
| Rate for Payer: Railroad Medicare Medicare |
$0.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.80
|
| Rate for Payer: UHC Exchange |
$1.24
|
| Rate for Payer: UHC Medicare Advantage |
$0.80
|
| Rate for Payer: UHCCP DNSP |
$0.80
|
| Rate for Payer: UHCCP Medicaid |
$0.43
|
| Rate for Payer: VA VA |
$0.80
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 65162089903
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.65 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: ASR ASR |
$136.77
|
| Rate for Payer: ASR Commercial |
$136.77
|
| Rate for Payer: BCBS Trust/PPO |
$114.90
|
| Rate for Payer: BCN Commercial |
$109.32
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$141.00
|
| Rate for Payer: Healthscope Whirlpool |
$136.77
|
| Rate for Payer: Mclaren Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.08
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
OP
|
$125.57
|
|
|
Service Code
|
NDC 50268009012
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.23 |
| Max. Negotiated Rate |
$125.57 |
| Rate for Payer: Aetna Commercial |
$113.01
|
| Rate for Payer: Aetna Medicare |
$62.78
|
| Rate for Payer: ASR ASR |
$121.80
|
| Rate for Payer: ASR Commercial |
$121.80
|
| Rate for Payer: BCBS Complete |
$50.23
|
| Rate for Payer: BCBS Trust/PPO |
$102.83
|
| Rate for Payer: BCN Commercial |
$97.35
|
| Rate for Payer: Cash Price |
$100.45
|
| Rate for Payer: Cofinity Commercial |
$118.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.46
|
| Rate for Payer: Healthscope Commercial |
$125.57
|
| Rate for Payer: Healthscope Whirlpool |
$121.80
|
| Rate for Payer: Mclaren Commercial |
$113.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.73
|
| Rate for Payer: Nomi Health Commercial |
$102.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.02
|
| Rate for Payer: Priority Health Narrow Network |
$88.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.50
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
IP
|
$6.28
|
|
|
Service Code
|
NDC 50268009011
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$6.28 |
| Rate for Payer: Aetna Commercial |
$5.65
|
| Rate for Payer: ASR ASR |
$6.09
|
| Rate for Payer: ASR Commercial |
$6.09
|
| Rate for Payer: BCBS Trust/PPO |
$5.12
|
| Rate for Payer: BCN Commercial |
$4.87
|
| Rate for Payer: Cash Price |
$5.02
|
| Rate for Payer: Cofinity Commercial |
$5.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.02
|
| Rate for Payer: Healthscope Commercial |
$6.28
|
| Rate for Payer: Healthscope Whirlpool |
$6.09
|
| Rate for Payer: Mclaren Commercial |
$5.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.34
|
| Rate for Payer: Nomi Health Commercial |
$5.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.53
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
IP
|
$125.57
|
|
|
Service Code
|
NDC 50268009012
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.62 |
| Max. Negotiated Rate |
$125.57 |
| Rate for Payer: Aetna Commercial |
$113.01
|
| Rate for Payer: ASR ASR |
$121.80
|
| Rate for Payer: ASR Commercial |
$121.80
|
| Rate for Payer: BCBS Trust/PPO |
$102.33
|
| Rate for Payer: BCN Commercial |
$97.35
|
| Rate for Payer: Cash Price |
$100.45
|
| Rate for Payer: Cofinity Commercial |
$118.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.46
|
| Rate for Payer: Healthscope Commercial |
$125.57
|
| Rate for Payer: Healthscope Whirlpool |
$121.80
|
| Rate for Payer: Mclaren Commercial |
$113.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.73
|
| Rate for Payer: Nomi Health Commercial |
$102.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.50
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 65162089903
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: ASR ASR |
$136.77
|
| Rate for Payer: ASR Commercial |
$136.77
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS Trust/PPO |
$115.46
|
| Rate for Payer: BCN Commercial |
$109.32
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$141.00
|
| Rate for Payer: Healthscope Whirlpool |
$136.77
|
| Rate for Payer: Mclaren Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.54
|
| Rate for Payer: Priority Health Narrow Network |
$98.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.08
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
OP
|
$6.28
|
|
|
Service Code
|
NDC 50268009011
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$6.28 |
| Rate for Payer: Aetna Commercial |
$5.65
|
| Rate for Payer: Aetna Medicare |
$3.14
|
| Rate for Payer: ASR ASR |
$6.09
|
| Rate for Payer: ASR Commercial |
$6.09
|
| Rate for Payer: BCBS Complete |
$2.51
|
| Rate for Payer: BCBS Trust/PPO |
$5.14
|
| Rate for Payer: BCN Commercial |
$4.87
|
| Rate for Payer: Cash Price |
$5.02
|
| Rate for Payer: Cofinity Commercial |
$5.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.02
|
| Rate for Payer: Healthscope Commercial |
$6.28
|
| Rate for Payer: Healthscope Whirlpool |
$6.09
|
| Rate for Payer: Mclaren Commercial |
$5.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.34
|
| Rate for Payer: Nomi Health Commercial |
$5.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.50
|
| Rate for Payer: Priority Health Narrow Network |
$4.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.53
|
|
|
ARIPIPRAZOLE 20 MG TABLET
|
Facility
|
OP
|
$85.78
|
|
|
Service Code
|
NDC 65162090103
|
| Hospital Charge Code |
34371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.31 |
| Max. Negotiated Rate |
$85.78 |
| Rate for Payer: Aetna Commercial |
$77.20
|
| Rate for Payer: Aetna Medicare |
$42.89
|
| Rate for Payer: ASR ASR |
$83.21
|
| Rate for Payer: ASR Commercial |
$83.21
|
| Rate for Payer: BCBS Complete |
$34.31
|
| Rate for Payer: BCBS Trust/PPO |
$70.25
|
| Rate for Payer: BCN Commercial |
$66.51
|
| Rate for Payer: Cash Price |
$68.63
|
| Rate for Payer: Cofinity Commercial |
$80.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.62
|
| Rate for Payer: Healthscope Commercial |
$85.78
|
| Rate for Payer: Healthscope Whirlpool |
$83.21
|
| Rate for Payer: Mclaren Commercial |
$77.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.91
|
| Rate for Payer: Nomi Health Commercial |
$70.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.16
|
| Rate for Payer: Priority Health Narrow Network |
$60.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.49
|
|
|
ARIPIPRAZOLE 20 MG TABLET
|
Facility
|
IP
|
$85.78
|
|
|
Service Code
|
NDC 65162090103
|
| Hospital Charge Code |
34371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.76 |
| Max. Negotiated Rate |
$85.78 |
| Rate for Payer: Aetna Commercial |
$77.20
|
| Rate for Payer: ASR ASR |
$83.21
|
| Rate for Payer: ASR Commercial |
$83.21
|
| Rate for Payer: BCBS Trust/PPO |
$69.90
|
| Rate for Payer: BCN Commercial |
$66.51
|
| Rate for Payer: Cash Price |
$68.63
|
| Rate for Payer: Cofinity Commercial |
$80.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.62
|
| Rate for Payer: Healthscope Commercial |
$85.78
|
| Rate for Payer: Healthscope Whirlpool |
$83.21
|
| Rate for Payer: Mclaren Commercial |
$77.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.91
|
| Rate for Payer: Nomi Health Commercial |
$70.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.49
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
OP
|
$81.22
|
|
|
Service Code
|
NDC 65162089703
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$81.22 |
| Rate for Payer: Aetna Commercial |
$73.10
|
| Rate for Payer: Aetna Medicare |
$40.61
|
| Rate for Payer: ASR ASR |
$78.78
|
| Rate for Payer: ASR Commercial |
$78.78
|
| Rate for Payer: BCBS Complete |
$32.49
|
| Rate for Payer: BCBS Trust/PPO |
$66.51
|
| Rate for Payer: BCN Commercial |
$62.97
|
| Rate for Payer: Cash Price |
$64.98
|
| Rate for Payer: Cofinity Commercial |
$76.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.98
|
| Rate for Payer: Healthscope Commercial |
$81.22
|
| Rate for Payer: Healthscope Whirlpool |
$78.78
|
| Rate for Payer: Mclaren Commercial |
$73.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.04
|
| Rate for Payer: Nomi Health Commercial |
$66.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.16
|
| Rate for Payer: Priority Health Narrow Network |
$56.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.47
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
IP
|
$81.22
|
|
|
Service Code
|
NDC 65162089703
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.79 |
| Max. Negotiated Rate |
$81.22 |
| Rate for Payer: Aetna Commercial |
$73.10
|
| Rate for Payer: ASR ASR |
$78.78
|
| Rate for Payer: ASR Commercial |
$78.78
|
| Rate for Payer: BCBS Trust/PPO |
$66.19
|
| Rate for Payer: BCN Commercial |
$62.97
|
| Rate for Payer: Cash Price |
$64.98
|
| Rate for Payer: Cofinity Commercial |
$76.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.98
|
| Rate for Payer: Healthscope Commercial |
$81.22
|
| Rate for Payer: Healthscope Whirlpool |
$78.78
|
| Rate for Payer: Mclaren Commercial |
$73.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.04
|
| Rate for Payer: Nomi Health Commercial |
$66.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.47
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$446.23
|
|
|
Service Code
|
CPT 20610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$446.23 |
| Rate for Payer: Aetna Medicare |
$287.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$287.89
|
| Rate for Payer: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Commercial |
$316.68
|
| Rate for Payer: PHP Medicaid |
$154.31
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Exchange |
$446.23
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP DNSP |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$154.31
|
| Rate for Payer: VA VA |
$287.89
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
|
OP
|
$100.62
|
|
|
Service Code
|
NDC 00065042636
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$100.62 |
| Rate for Payer: Aetna Commercial |
$90.56
|
| Rate for Payer: Aetna Medicare |
$50.31
|
| Rate for Payer: ASR ASR |
$97.60
|
| Rate for Payer: ASR Commercial |
$97.60
|
| Rate for Payer: BCBS Complete |
$40.25
|
| Rate for Payer: BCBS Trust/PPO |
$82.40
|
| Rate for Payer: BCN Commercial |
$78.01
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cofinity Commercial |
$94.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.50
|
| Rate for Payer: Healthscope Commercial |
$100.62
|
| Rate for Payer: Healthscope Whirlpool |
$97.60
|
| Rate for Payer: Mclaren Commercial |
$90.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.53
|
| Rate for Payer: Nomi Health Commercial |
$82.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.16
|
| Rate for Payer: Priority Health Narrow Network |
$70.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.55
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
|
IP
|
$25.38
|
|
|
Service Code
|
NDC 57896018105
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna Commercial |
$22.84
|
| Rate for Payer: ASR ASR |
$24.62
|
| Rate for Payer: ASR Commercial |
$24.62
|
| Rate for Payer: BCBS Trust/PPO |
$20.68
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cofinity Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.30
|
| Rate for Payer: Healthscope Commercial |
$25.38
|
| Rate for Payer: Healthscope Whirlpool |
$24.62
|
| Rate for Payer: Mclaren Commercial |
$22.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.57
|
| Rate for Payer: Nomi Health Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.33
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
|
IP
|
$100.62
|
|
|
Service Code
|
NDC 00065042636
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$100.62 |
| Rate for Payer: Aetna Commercial |
$90.56
|
| Rate for Payer: ASR ASR |
$97.60
|
| Rate for Payer: ASR Commercial |
$97.60
|
| Rate for Payer: BCBS Trust/PPO |
$82.00
|
| Rate for Payer: BCN Commercial |
$78.01
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cofinity Commercial |
$94.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.50
|
| Rate for Payer: Healthscope Commercial |
$100.62
|
| Rate for Payer: Healthscope Whirlpool |
$97.60
|
| Rate for Payer: Mclaren Commercial |
$90.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.53
|
| Rate for Payer: Nomi Health Commercial |
$82.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.55
|
|
|
ARTIFICIAL TEARS EYE DROPS WRAPPER
|
Facility
|
OP
|
$25.38
|
|
|
Service Code
|
NDC 57896018105
|
| Hospital Charge Code |
301578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna Commercial |
$22.84
|
| Rate for Payer: Aetna Medicare |
$12.69
|
| Rate for Payer: ASR ASR |
$24.62
|
| Rate for Payer: ASR Commercial |
$24.62
|
| Rate for Payer: BCBS Complete |
$10.15
|
| Rate for Payer: BCBS Trust/PPO |
$20.78
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cofinity Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.30
|
| Rate for Payer: Healthscope Commercial |
$25.38
|
| Rate for Payer: Healthscope Whirlpool |
$24.62
|
| Rate for Payer: Mclaren Commercial |
$22.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.57
|
| Rate for Payer: Nomi Health Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.24
|
| Rate for Payer: Priority Health Narrow Network |
$17.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.33
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 00904052361
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.83 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna Commercial |
$63.45
|
| Rate for Payer: ASR ASR |
$68.39
|
| Rate for Payer: ASR Commercial |
$68.39
|
| Rate for Payer: BCBS Trust/PPO |
$57.45
|
| Rate for Payer: BCN Commercial |
$54.66
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$66.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$70.50
|
| Rate for Payer: Healthscope Whirlpool |
$68.39
|
| Rate for Payer: Mclaren Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Nomi Health Commercial |
$57.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.04
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG TABLET
|
Facility
|
OP
|
$70.50
|
|
|
Service Code
|
NDC 00904052361
|
| Hospital Charge Code |
664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna Commercial |
$63.45
|
| Rate for Payer: Aetna Medicare |
$35.25
|
| Rate for Payer: ASR ASR |
$68.39
|
| Rate for Payer: ASR Commercial |
$68.39
|
| Rate for Payer: BCBS Complete |
$28.20
|
| Rate for Payer: BCBS Trust/PPO |
$57.73
|
| Rate for Payer: BCN Commercial |
$54.66
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$66.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$70.50
|
| Rate for Payer: Healthscope Whirlpool |
$68.39
|
| Rate for Payer: Mclaren Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Nomi Health Commercial |
$57.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.77
|
| Rate for Payer: Priority Health Narrow Network |
$49.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.04
|
|
|
ASPIRIN 300 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$39.78
|
|
|
Service Code
|
NDC 00574703412
|
| Hospital Charge Code |
693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.86 |
| Max. Negotiated Rate |
$39.78 |
| Rate for Payer: Aetna Commercial |
$35.80
|
| Rate for Payer: ASR ASR |
$38.59
|
| Rate for Payer: ASR Commercial |
$38.59
|
| Rate for Payer: BCBS Trust/PPO |
$32.42
|
| Rate for Payer: BCN Commercial |
$30.84
|
| Rate for Payer: Cash Price |
$31.83
|
| Rate for Payer: Cofinity Commercial |
$37.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$39.78
|
| Rate for Payer: Healthscope Whirlpool |
$38.59
|
| Rate for Payer: Mclaren Commercial |
$35.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.81
|
| Rate for Payer: Nomi Health Commercial |
$32.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.01
|
|
|
ASPIRIN 300 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$39.78
|
|
|
Service Code
|
NDC 00574703412
|
| Hospital Charge Code |
693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$39.78 |
| Rate for Payer: Aetna Commercial |
$35.80
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: ASR ASR |
$38.59
|
| Rate for Payer: ASR Commercial |
$38.59
|
| Rate for Payer: BCBS Complete |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$32.58
|
| Rate for Payer: BCN Commercial |
$30.84
|
| Rate for Payer: Cash Price |
$31.83
|
| Rate for Payer: Cofinity Commercial |
$37.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$39.78
|
| Rate for Payer: Healthscope Whirlpool |
$38.59
|
| Rate for Payer: Mclaren Commercial |
$35.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.81
|
| Rate for Payer: Nomi Health Commercial |
$32.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.86
|
| Rate for Payer: Priority Health Narrow Network |
$27.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.01
|
|
