|
PAROXETINE 20 MG TABLET
|
Facility
|
IP
|
$321.95
|
|
|
Service Code
|
NDC 63739096310
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.46 |
| Max. Negotiated Rate |
$321.95 |
| Rate for Payer: Aetna Commercial |
$289.75
|
| Rate for Payer: ASR ASR |
$312.29
|
| Rate for Payer: BCBS Trust/PPO |
$264.39
|
| Rate for Payer: BCN Commercial |
$264.39
|
| Rate for Payer: Cash Price |
$257.56
|
| Rate for Payer: Cofinity Commercial |
$302.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.56
|
| Rate for Payer: Healthscope Commercial |
$312.29
|
| Rate for Payer: Healthscope Whirlpool |
$321.95
|
| Rate for Payer: Mclaren Commercial |
$289.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.66
|
| Rate for Payer: Nomi Health Commercial |
$264.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.32
|
|
|
PAROXETINE 20 MG TABLET
|
Facility
|
OP
|
$425.35
|
|
|
Service Code
|
NDC 904567761
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.38 |
| Max. Negotiated Rate |
$425.35 |
| Rate for Payer: Aetna Commercial |
$382.81
|
| Rate for Payer: Aetna Medicare |
$157.38
|
| Rate for Payer: ASR ASR |
$412.59
|
| Rate for Payer: BCBS Complete |
$170.14
|
| Rate for Payer: BCBS Trust/PPO |
$350.70
|
| Rate for Payer: BCN Commercial |
$350.70
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cofinity Commercial |
$399.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Healthscope Commercial |
$412.59
|
| Rate for Payer: Healthscope Whirlpool |
$425.35
|
| Rate for Payer: Mclaren Commercial |
$382.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$340.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.55
|
| Rate for Payer: Nomi Health Commercial |
$348.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$372.69
|
| Rate for Payer: Priority Health Narrow Network |
$298.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$374.31
|
|
|
PAROXETINE 20 MG TABLET
|
Facility
|
OP
|
$321.95
|
|
|
Service Code
|
NDC 63739096310
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.12 |
| Max. Negotiated Rate |
$321.95 |
| Rate for Payer: Aetna Commercial |
$289.75
|
| Rate for Payer: Aetna Medicare |
$119.12
|
| Rate for Payer: ASR ASR |
$312.29
|
| Rate for Payer: BCBS Complete |
$128.78
|
| Rate for Payer: BCBS Trust/PPO |
$265.45
|
| Rate for Payer: BCN Commercial |
$265.45
|
| Rate for Payer: Cash Price |
$257.56
|
| Rate for Payer: Cofinity Commercial |
$302.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.56
|
| Rate for Payer: Healthscope Commercial |
$312.29
|
| Rate for Payer: Healthscope Whirlpool |
$321.95
|
| Rate for Payer: Mclaren Commercial |
$289.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.66
|
| Rate for Payer: Nomi Health Commercial |
$264.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$282.09
|
| Rate for Payer: Priority Health Narrow Network |
$225.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.32
|
|
|
PAROXETINE 20 MG TABLET
|
Facility
|
IP
|
$425.35
|
|
|
Service Code
|
NDC 904567761
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$319.01 |
| Max. Negotiated Rate |
$425.35 |
| Rate for Payer: Aetna Commercial |
$382.81
|
| Rate for Payer: ASR ASR |
$412.59
|
| Rate for Payer: BCBS Trust/PPO |
$349.30
|
| Rate for Payer: BCN Commercial |
$349.30
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cofinity Commercial |
$399.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Healthscope Commercial |
$412.59
|
| Rate for Payer: Healthscope Whirlpool |
$425.35
|
| Rate for Payer: Mclaren Commercial |
$382.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.55
|
| Rate for Payer: Nomi Health Commercial |
$348.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$374.31
|
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$5,497.46
|
|
|
Service Code
|
APR-DRG 8442
|
| Min. Negotiated Rate |
$4,970.36 |
| Max. Negotiated Rate |
$5,497.46 |
| Rate for Payer: BCBS Complete |
$5,497.46
|
| Rate for Payer: Mclaren Medicaid |
$5,235.67
|
| Rate for Payer: Meridian Medicaid |
$5,497.46
|
| Rate for Payer: PHP Medicaid |
$4,970.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,235.67
|
| Rate for Payer: UHC Medicaid |
$5,235.67
|
| Rate for Payer: UHCCP Medicaid |
$5,235.67
|
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$7,655.46
|
|
|
Service Code
|
APR-DRG 8443
|
| Min. Negotiated Rate |
$6,921.45 |
| Max. Negotiated Rate |
$7,655.46 |
| Rate for Payer: BCBS Complete |
$7,655.46
|
| Rate for Payer: Mclaren Medicaid |
$7,290.91
|
| Rate for Payer: Meridian Medicaid |
$7,655.46
|
| Rate for Payer: PHP Medicaid |
$6,921.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,290.91
|
| Rate for Payer: UHC Medicaid |
$7,290.91
|
| Rate for Payer: UHCCP Medicaid |
$7,290.91
|
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$12,381.81
|
|
|
Service Code
|
APR-DRG 8444
|
| Min. Negotiated Rate |
$11,194.64 |
| Max. Negotiated Rate |
$12,381.81 |
| Rate for Payer: BCBS Complete |
$12,381.81
|
| Rate for Payer: Mclaren Medicaid |
$11,792.20
|
| Rate for Payer: Meridian Medicaid |
$12,381.81
|
| Rate for Payer: PHP Medicaid |
$11,194.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,792.20
|
| Rate for Payer: UHC Medicaid |
$11,792.20
|
| Rate for Payer: UHCCP Medicaid |
$11,792.20
|
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$3,038.10
|
|
|
Service Code
|
APR-DRG 8441
|
| Min. Negotiated Rate |
$2,746.80 |
| Max. Negotiated Rate |
$3,038.10 |
| Rate for Payer: BCBS Complete |
$3,038.10
|
| Rate for Payer: Mclaren Medicaid |
$2,893.43
|
| Rate for Payer: Meridian Medicaid |
$3,038.10
|
| Rate for Payer: PHP Medicaid |
$2,746.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,893.43
|
| Rate for Payer: UHC Medicaid |
$2,893.43
|
| Rate for Payer: UHCCP Medicaid |
$2,893.43
|
|
|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC
|
Facility
|
IP
|
$14,193.86
|
|
|
Service Code
|
MSDRG 543
|
| Min. Negotiated Rate |
$8,699.46 |
| Max. Negotiated Rate |
$14,193.86 |
| Rate for Payer: Aetna Medicare |
$9,157.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,446.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,446.66
|
| Rate for Payer: BCBS MAPPO |
$9,157.33
|
| Rate for Payer: BCN Medicare Advantage |
$9,157.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,157.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,157.33
|
| Rate for Payer: Mclaren Medicare |
$9,157.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,615.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,530.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,073.06
|
| Rate for Payer: PACE Medicare |
$8,699.46
|
| Rate for Payer: PACE SWMI |
$9,157.33
|
| Rate for Payer: PHP Commercial |
$10,073.06
|
| Rate for Payer: PHP Medicare Advantage |
$9,157.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,123.49
|
| Rate for Payer: Priority Health Medicare |
$9,157.33
|
| Rate for Payer: Priority Health Narrow Network |
$11,298.79
|
| Rate for Payer: Railroad Medicare Medicare |
$9,157.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,157.33
|
| Rate for Payer: UHC Exchange |
$14,193.86
|
| Rate for Payer: UHCCP DNSP |
$9,157.33
|
| Rate for Payer: VA VA |
$9,157.33
|
|
|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC
|
Facility
|
IP
|
$24,269.59
|
|
|
Service Code
|
MSDRG 542
|
| Min. Negotiated Rate |
$13,751.68 |
| Max. Negotiated Rate |
$24,269.59 |
| Rate for Payer: Aetna Medicare |
$14,475.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,094.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,094.31
|
| Rate for Payer: BCBS MAPPO |
$14,475.45
|
| Rate for Payer: BCN Medicare Advantage |
$14,475.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,475.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,475.45
|
| Rate for Payer: Mclaren Medicare |
$14,475.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,199.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,646.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,923.00
|
| Rate for Payer: PACE Medicare |
$13,751.68
|
| Rate for Payer: PACE SWMI |
$14,475.45
|
| Rate for Payer: PHP Commercial |
$15,923.00
|
| Rate for Payer: PHP Medicare Advantage |
$14,475.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$24,269.59
|
| Rate for Payer: Priority Health Medicare |
$14,475.45
|
| Rate for Payer: Priority Health Narrow Network |
$19,415.67
|
| Rate for Payer: Railroad Medicare Medicare |
$14,475.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,475.45
|
| Rate for Payer: UHC Exchange |
$22,436.95
|
| Rate for Payer: UHCCP DNSP |
$14,475.45
|
| Rate for Payer: VA VA |
$14,475.45
|
|
|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$11,142.21
|
|
|
Service Code
|
MSDRG 544
|
| Min. Negotiated Rate |
$6,829.09 |
| Max. Negotiated Rate |
$11,142.21 |
| Rate for Payer: Aetna Medicare |
$7,188.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,985.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,985.65
|
| Rate for Payer: BCBS MAPPO |
$7,188.52
|
| Rate for Payer: BCN Medicare Advantage |
$7,188.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,188.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,188.52
|
| Rate for Payer: Mclaren Medicare |
$7,188.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,547.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,266.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,907.37
|
| Rate for Payer: PACE Medicare |
$6,829.09
|
| Rate for Payer: PACE SWMI |
$7,188.52
|
| Rate for Payer: PHP Commercial |
$7,907.37
|
| Rate for Payer: PHP Medicare Advantage |
$7,188.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,367.30
|
| Rate for Payer: Priority Health Medicare |
$7,188.52
|
| Rate for Payer: Priority Health Narrow Network |
$8,293.84
|
| Rate for Payer: Railroad Medicare Medicare |
$7,188.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,188.52
|
| Rate for Payer: UHC Exchange |
$11,142.21
|
| Rate for Payer: UHCCP DNSP |
$7,188.52
|
| Rate for Payer: VA VA |
$7,188.52
|
|
|
PEDS ECHO LIMITED W/DEFINITY
|
Facility
|
OP
|
$1,411.79
|
|
|
Service Code
|
HCPCS C8922
|
| Hospital Charge Code |
48000029
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$1,411.79 |
| Rate for Payer: Aetna Commercial |
$1,270.61
|
| Rate for Payer: Aetna Medicare |
$781.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: ASR ASR |
$1,369.44
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,164.02
|
| Rate for Payer: BCN Commercial |
$1,164.02
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,129.43
|
| Rate for Payer: Cash Price |
$1,129.43
|
| Rate for Payer: Cofinity Commercial |
$1,327.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,129.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$1,369.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,411.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$781.10
|
| Rate for Payer: Mclaren Commercial |
$1,270.61
|
| Rate for Payer: Mclaren Medicaid |
$781.10
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$428.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.02
|
| Rate for Payer: Nomi Health Commercial |
$1,157.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,058.84
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$859.21
|
| Rate for Payer: PHP Medicaid |
$418.67
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,237.01
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health Narrow Network |
$989.66
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,242.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$1,210.70
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP DNSP |
$781.10
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
PEDS ECHO LIMITED W/DEFINITY
|
Facility
|
IP
|
$1,411.79
|
|
|
Service Code
|
HCPCS C8922
|
| Hospital Charge Code |
48000029
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,058.84 |
| Max. Negotiated Rate |
$1,411.79 |
| Rate for Payer: Aetna Commercial |
$1,270.61
|
| Rate for Payer: ASR ASR |
$1,369.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,159.36
|
| Rate for Payer: BCN Commercial |
$1,159.36
|
| Rate for Payer: Cash Price |
$1,129.43
|
| Rate for Payer: Cofinity Commercial |
$1,327.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,129.43
|
| Rate for Payer: Healthscope Commercial |
$1,369.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,411.79
|
| Rate for Payer: Mclaren Commercial |
$1,270.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.02
|
| Rate for Payer: Nomi Health Commercial |
$1,157.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,058.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,242.38
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
NDC 43386009019
|
| Hospital Charge Code |
10839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Medicare |
$20.72
|
| Rate for Payer: ASR ASR |
$54.32
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Trust/PPO |
$46.17
|
| Rate for Payer: BCN Commercial |
$46.17
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$54.32
|
| Rate for Payer: Healthscope Whirlpool |
$56.00
|
| Rate for Payer: Mclaren Commercial |
$50.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.60
|
| Rate for Payer: Nomi Health Commercial |
$45.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49.07
|
| Rate for Payer: Priority Health Narrow Network |
$39.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.28
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
NDC 52268010001
|
| Hospital Charge Code |
10839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: ASR ASR |
$67.90
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$57.48
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$65.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$67.90
|
| Rate for Payer: Healthscope Whirlpool |
$70.00
|
| Rate for Payer: Mclaren Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.50
|
| Rate for Payer: Nomi Health Commercial |
$57.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.60
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
NDC 52268010001
|
| Hospital Charge Code |
10839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Medicare |
$25.90
|
| Rate for Payer: ASR ASR |
$67.90
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS Trust/PPO |
$57.72
|
| Rate for Payer: BCN Commercial |
$57.72
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$65.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$67.90
|
| Rate for Payer: Healthscope Whirlpool |
$70.00
|
| Rate for Payer: Mclaren Commercial |
$63.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.50
|
| Rate for Payer: Nomi Health Commercial |
$57.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$61.33
|
| Rate for Payer: Priority Health Narrow Network |
$49.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.60
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
NDC 43386009019
|
| Hospital Charge Code |
10839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: ASR ASR |
$54.32
|
| Rate for Payer: BCBS Trust/PPO |
$45.99
|
| Rate for Payer: BCN Commercial |
$45.99
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$54.32
|
| Rate for Payer: Healthscope Whirlpool |
$56.00
|
| Rate for Payer: Mclaren Commercial |
$50.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.60
|
| Rate for Payer: Nomi Health Commercial |
$45.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.28
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
OP
|
$11.41
|
|
|
Service Code
|
NDC 96295013764
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$11.41 |
| Rate for Payer: Aetna Commercial |
$10.27
|
| Rate for Payer: Aetna Medicare |
$4.22
|
| Rate for Payer: ASR ASR |
$11.07
|
| Rate for Payer: BCBS Complete |
$4.56
|
| Rate for Payer: BCBS Trust/PPO |
$9.41
|
| Rate for Payer: BCN Commercial |
$9.41
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: Cofinity Commercial |
$10.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.13
|
| Rate for Payer: Healthscope Commercial |
$11.07
|
| Rate for Payer: Healthscope Whirlpool |
$11.41
|
| Rate for Payer: Mclaren Commercial |
$10.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.70
|
| Rate for Payer: Nomi Health Commercial |
$9.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.00
|
| Rate for Payer: Priority Health Narrow Network |
$8.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.04
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
IP
|
$11.41
|
|
|
Service Code
|
NDC 96295013764
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$11.41 |
| Rate for Payer: Aetna Commercial |
$10.27
|
| Rate for Payer: ASR ASR |
$11.07
|
| Rate for Payer: BCBS Trust/PPO |
$9.37
|
| Rate for Payer: BCN Commercial |
$9.37
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: Cofinity Commercial |
$10.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.13
|
| Rate for Payer: Healthscope Commercial |
$11.07
|
| Rate for Payer: Healthscope Whirlpool |
$11.41
|
| Rate for Payer: Mclaren Commercial |
$10.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.70
|
| Rate for Payer: Nomi Health Commercial |
$9.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.04
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
IP
|
$9.52
|
|
|
Service Code
|
NDC 57896018105
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$9.52 |
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: ASR ASR |
$9.23
|
| Rate for Payer: BCBS Trust/PPO |
$7.82
|
| Rate for Payer: BCN Commercial |
$7.82
|
| Rate for Payer: Cash Price |
$7.61
|
| Rate for Payer: Cofinity Commercial |
$8.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.61
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Healthscope Whirlpool |
$9.52
|
| Rate for Payer: Mclaren Commercial |
$8.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.09
|
| Rate for Payer: Nomi Health Commercial |
$7.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.38
|
|
|
PEG 400-HYPROMELLOSE-GLYCERIN 1 %-0.2 %-0.2 % EYE DROPS
|
Facility
|
OP
|
$9.52
|
|
|
Service Code
|
NDC 57896018105
|
| Hospital Charge Code |
41412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$9.52 |
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Aetna Medicare |
$3.52
|
| Rate for Payer: ASR ASR |
$9.23
|
| Rate for Payer: BCBS Complete |
$3.81
|
| Rate for Payer: BCBS Trust/PPO |
$7.85
|
| Rate for Payer: BCN Commercial |
$7.85
|
| Rate for Payer: Cash Price |
$7.61
|
| Rate for Payer: Cofinity Commercial |
$8.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.61
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Healthscope Whirlpool |
$9.52
|
| Rate for Payer: Mclaren Commercial |
$8.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.09
|
| Rate for Payer: Nomi Health Commercial |
$7.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.34
|
| Rate for Payer: Priority Health Narrow Network |
$6.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.38
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$16,067.54
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
32267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$16,067.54 |
| Rate for Payer: Aetna Commercial |
$14,460.79
|
| Rate for Payer: Aetna Medicare |
$127.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.22
|
| Rate for Payer: ASR ASR |
$15,585.51
|
| Rate for Payer: BCBS Complete |
$69.96
|
| Rate for Payer: BCBS MAPPO |
$127.38
|
| Rate for Payer: BCBS Trust/PPO |
$13,247.69
|
| Rate for Payer: BCN Commercial |
$13,247.69
|
| Rate for Payer: BCN Medicare Advantage |
$127.38
|
| Rate for Payer: Cash Price |
$12,854.03
|
| Rate for Payer: Cash Price |
$12,854.03
|
| Rate for Payer: Cofinity Commercial |
$15,103.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,854.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.38
|
| Rate for Payer: Healthscope Commercial |
$15,585.51
|
| Rate for Payer: Healthscope Whirlpool |
$16,067.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$127.38
|
| Rate for Payer: Mclaren Commercial |
$14,460.79
|
| Rate for Payer: Mclaren Medicaid |
$127.38
|
| Rate for Payer: Mclaren Medicare |
$127.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.75
|
| Rate for Payer: Meridian Medicaid |
$69.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$140.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,657.41
|
| Rate for Payer: Nomi Health Commercial |
$13,175.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,050.66
|
| Rate for Payer: PACE Medicare |
$121.01
|
| Rate for Payer: PACE SWMI |
$127.38
|
| Rate for Payer: PHP Commercial |
$140.12
|
| Rate for Payer: PHP Medicaid |
$68.28
|
| Rate for Payer: PHP Medicare Advantage |
$127.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$127.47
|
| Rate for Payer: Priority Health Medicare |
$127.38
|
| Rate for Payer: Priority Health Narrow Network |
$101.98
|
| Rate for Payer: Railroad Medicare Medicare |
$127.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,139.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$127.38
|
| Rate for Payer: UHC Exchange |
$197.44
|
| Rate for Payer: UHC Medicaid |
$66.62
|
| Rate for Payer: UHCCP DNSP |
$127.38
|
| Rate for Payer: UHCCP Medicaid |
$66.62
|
| Rate for Payer: VA VA |
$127.38
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$16,067.54
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
32267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12,050.66 |
| Max. Negotiated Rate |
$16,067.54 |
| Rate for Payer: Aetna Commercial |
$14,460.79
|
| Rate for Payer: ASR ASR |
$15,585.51
|
| Rate for Payer: BCBS Trust/PPO |
$13,194.66
|
| Rate for Payer: BCN Commercial |
$13,194.66
|
| Rate for Payer: Cash Price |
$12,854.03
|
| Rate for Payer: Cofinity Commercial |
$15,103.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,854.03
|
| Rate for Payer: Healthscope Commercial |
$15,585.51
|
| Rate for Payer: Healthscope Whirlpool |
$16,067.54
|
| Rate for Payer: Mclaren Commercial |
$14,460.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,657.41
|
| Rate for Payer: Nomi Health Commercial |
$13,175.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,050.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,139.44
|
|
|
PEGFILGRASTIM-BMEZ 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$9,951.21
|
|
|
Service Code
|
HCPCS Q5120
|
| Hospital Charge Code |
192102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,463.41 |
| Max. Negotiated Rate |
$9,951.21 |
| Rate for Payer: Aetna Commercial |
$8,956.09
|
| Rate for Payer: ASR ASR |
$9,652.68
|
| Rate for Payer: BCBS Trust/PPO |
$8,171.94
|
| Rate for Payer: BCN Commercial |
$8,171.94
|
| Rate for Payer: Cash Price |
$7,960.97
|
| Rate for Payer: Cofinity Commercial |
$9,354.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,960.97
|
| Rate for Payer: Healthscope Commercial |
$9,652.68
|
| Rate for Payer: Healthscope Whirlpool |
$9,951.21
|
| Rate for Payer: Mclaren Commercial |
$8,956.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,458.53
|
| Rate for Payer: Nomi Health Commercial |
$8,160.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,463.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,757.07
|
|
|
PEGFILGRASTIM-BMEZ 6 MG/0.6 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$9,951.21
|
|
|
Service Code
|
HCPCS Q5120
|
| Hospital Charge Code |
192102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.57 |
| Max. Negotiated Rate |
$9,951.21 |
| Rate for Payer: Aetna Commercial |
$8,956.09
|
| Rate for Payer: Aetna Medicare |
$119.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$149.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$149.55
|
| Rate for Payer: ASR ASR |
$9,652.68
|
| Rate for Payer: BCBS Complete |
$65.71
|
| Rate for Payer: BCBS MAPPO |
$119.64
|
| Rate for Payer: BCBS Trust/PPO |
$8,204.78
|
| Rate for Payer: BCN Commercial |
$8,204.78
|
| Rate for Payer: BCN Medicare Advantage |
$119.64
|
| Rate for Payer: Cash Price |
$7,960.97
|
| Rate for Payer: Cash Price |
$7,960.97
|
| Rate for Payer: Cofinity Commercial |
$9,354.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,960.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.64
|
| Rate for Payer: Healthscope Commercial |
$9,652.68
|
| Rate for Payer: Healthscope Whirlpool |
$9,951.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$119.64
|
| Rate for Payer: Mclaren Commercial |
$8,956.09
|
| Rate for Payer: Mclaren Medicaid |
$119.64
|
| Rate for Payer: Mclaren Medicare |
$119.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.62
|
| Rate for Payer: Meridian Medicaid |
$65.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$137.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$131.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,458.53
|
| Rate for Payer: Nomi Health Commercial |
$8,160.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,463.41
|
| Rate for Payer: PACE Medicare |
$113.66
|
| Rate for Payer: PACE SWMI |
$119.64
|
| Rate for Payer: PHP Commercial |
$131.60
|
| Rate for Payer: PHP Medicaid |
$64.13
|
| Rate for Payer: PHP Medicare Advantage |
$119.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$121.03
|
| Rate for Payer: Priority Health Medicare |
$119.64
|
| Rate for Payer: Priority Health Narrow Network |
$96.82
|
| Rate for Payer: Railroad Medicare Medicare |
$119.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,757.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$119.64
|
| Rate for Payer: UHC Exchange |
$185.44
|
| Rate for Payer: UHC Medicaid |
$62.57
|
| Rate for Payer: UHCCP DNSP |
$119.64
|
| Rate for Payer: UHCCP Medicaid |
$62.57
|
| Rate for Payer: VA VA |
$119.64
|
|
