|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK
|
Facility
|
IP
|
$15,972.48
|
|
|
Service Code
|
APR-DRG 1702
|
| Min. Negotiated Rate |
$14,441.04 |
| Max. Negotiated Rate |
$15,972.48 |
| Rate for Payer: BCBS Complete |
$15,972.48
|
| Rate for Payer: Mclaren Medicaid |
$15,211.89
|
| Rate for Payer: Meridian Medicaid |
$15,972.48
|
| Rate for Payer: PHP Medicaid |
$14,441.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,211.89
|
| Rate for Payer: UHC Medicaid |
$15,211.89
|
| Rate for Payer: UHCCP Medicaid |
$15,211.89
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK
|
Facility
|
IP
|
$11,830.86
|
|
|
Service Code
|
APR-DRG 1701
|
| Min. Negotiated Rate |
$10,696.52 |
| Max. Negotiated Rate |
$11,830.86 |
| Rate for Payer: BCBS Complete |
$11,830.86
|
| Rate for Payer: Mclaren Medicaid |
$11,267.49
|
| Rate for Payer: Meridian Medicaid |
$11,830.86
|
| Rate for Payer: PHP Medicaid |
$10,696.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,267.49
|
| Rate for Payer: UHC Medicaid |
$11,267.49
|
| Rate for Payer: UHCCP Medicaid |
$11,267.49
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK
|
Facility
|
IP
|
$38,287.10
|
|
|
Service Code
|
APR-DRG 1704
|
| Min. Negotiated Rate |
$34,616.12 |
| Max. Negotiated Rate |
$38,287.10 |
| Rate for Payer: BCBS Complete |
$38,287.10
|
| Rate for Payer: Mclaren Medicaid |
$36,463.90
|
| Rate for Payer: Meridian Medicaid |
$38,287.10
|
| Rate for Payer: PHP Medicaid |
$34,616.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$36,463.90
|
| Rate for Payer: UHC Medicaid |
$36,463.90
|
| Rate for Payer: UHCCP Medicaid |
$36,463.90
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK
|
Facility
|
IP
|
$23,206.70
|
|
|
Service Code
|
APR-DRG 1703
|
| Min. Negotiated Rate |
$20,981.63 |
| Max. Negotiated Rate |
$23,206.70 |
| Rate for Payer: BCBS Complete |
$23,206.70
|
| Rate for Payer: Mclaren Medicaid |
$22,101.62
|
| Rate for Payer: Meridian Medicaid |
$23,206.70
|
| Rate for Payer: PHP Medicaid |
$20,981.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,101.62
|
| Rate for Payer: UHC Medicaid |
$22,101.62
|
| Rate for Payer: UHCCP Medicaid |
$22,101.62
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC
|
Facility
|
IP
|
$29,276.01
|
|
|
Service Code
|
MSDRG 243
|
| Min. Negotiated Rate |
$16,244.61 |
| Max. Negotiated Rate |
$29,276.01 |
| Rate for Payer: Aetna Medicare |
$17,099.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,374.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,374.49
|
| Rate for Payer: BCBS MAPPO |
$17,099.59
|
| Rate for Payer: BCN Medicare Advantage |
$17,099.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,099.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,099.59
|
| Rate for Payer: Mclaren Medicare |
$17,099.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,954.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,664.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,809.55
|
| Rate for Payer: PACE Medicare |
$16,244.61
|
| Rate for Payer: PACE SWMI |
$17,099.59
|
| Rate for Payer: PHP Commercial |
$18,809.55
|
| Rate for Payer: PHP Medicare Advantage |
$17,099.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29,276.01
|
| Rate for Payer: Priority Health Medicare |
$17,099.59
|
| Rate for Payer: Priority Health Narrow Network |
$23,420.81
|
| Rate for Payer: Railroad Medicare Medicare |
$17,099.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,099.59
|
| Rate for Payer: UHC Exchange |
$26,504.36
|
| Rate for Payer: UHCCP DNSP |
$17,099.59
|
| Rate for Payer: VA VA |
$17,099.59
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC
|
Facility
|
IP
|
$43,865.24
|
|
|
Service Code
|
MSDRG 242
|
| Min. Negotiated Rate |
$23,509.26 |
| Max. Negotiated Rate |
$43,865.24 |
| Rate for Payer: Aetna Medicare |
$24,746.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,933.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,933.24
|
| Rate for Payer: BCBS MAPPO |
$24,746.59
|
| Rate for Payer: BCN Medicare Advantage |
$24,746.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,746.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,746.59
|
| Rate for Payer: Mclaren Medicare |
$24,746.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,983.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,458.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$27,221.25
|
| Rate for Payer: PACE Medicare |
$23,509.26
|
| Rate for Payer: PACE SWMI |
$24,746.59
|
| Rate for Payer: PHP Commercial |
$27,221.25
|
| Rate for Payer: PHP Medicare Advantage |
$24,746.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$43,865.24
|
| Rate for Payer: Priority Health Medicare |
$24,746.59
|
| Rate for Payer: Priority Health Narrow Network |
$35,092.19
|
| Rate for Payer: Railroad Medicare Medicare |
$24,746.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24,746.59
|
| Rate for Payer: UHC Exchange |
$38,357.21
|
| Rate for Payer: UHCCP DNSP |
$24,746.59
|
| Rate for Payer: VA VA |
$24,746.59
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK
|
Facility
|
IP
|
$12,007.43
|
|
|
Service Code
|
APR-DRG 1712
|
| Min. Negotiated Rate |
$10,856.15 |
| Max. Negotiated Rate |
$12,007.43 |
| Rate for Payer: BCBS Complete |
$12,007.43
|
| Rate for Payer: Mclaren Medicaid |
$11,435.65
|
| Rate for Payer: Meridian Medicaid |
$12,007.43
|
| Rate for Payer: PHP Medicaid |
$10,856.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,435.65
|
| Rate for Payer: UHC Medicaid |
$11,435.65
|
| Rate for Payer: UHCCP Medicaid |
$11,435.65
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK
|
Facility
|
IP
|
$9,260.88
|
|
|
Service Code
|
APR-DRG 1711
|
| Min. Negotiated Rate |
$8,372.94 |
| Max. Negotiated Rate |
$9,260.88 |
| Rate for Payer: BCBS Complete |
$9,260.88
|
| Rate for Payer: Mclaren Medicaid |
$8,819.89
|
| Rate for Payer: Meridian Medicaid |
$9,260.88
|
| Rate for Payer: PHP Medicaid |
$8,372.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,819.89
|
| Rate for Payer: UHC Medicaid |
$8,819.89
|
| Rate for Payer: UHCCP Medicaid |
$8,819.89
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK
|
Facility
|
IP
|
$16,500.54
|
|
|
Service Code
|
APR-DRG 1713
|
| Min. Negotiated Rate |
$14,918.46 |
| Max. Negotiated Rate |
$16,500.54 |
| Rate for Payer: BCBS Complete |
$16,500.54
|
| Rate for Payer: Mclaren Medicaid |
$15,714.80
|
| Rate for Payer: Meridian Medicaid |
$16,500.54
|
| Rate for Payer: PHP Medicaid |
$14,918.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,714.80
|
| Rate for Payer: UHC Medicaid |
$15,714.80
|
| Rate for Payer: UHCCP Medicaid |
$15,714.80
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK
|
Facility
|
IP
|
$23,623.58
|
|
|
Service Code
|
APR-DRG 1714
|
| Min. Negotiated Rate |
$21,358.54 |
| Max. Negotiated Rate |
$23,623.58 |
| Rate for Payer: BCBS Complete |
$23,623.58
|
| Rate for Payer: Mclaren Medicaid |
$22,498.65
|
| Rate for Payer: Meridian Medicaid |
$23,623.58
|
| Rate for Payer: PHP Medicaid |
$21,358.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,498.65
|
| Rate for Payer: UHC Medicaid |
$22,498.65
|
| Rate for Payer: UHCCP Medicaid |
$22,498.65
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC
|
Facility
|
IP
|
$24,832.88
|
|
|
Service Code
|
MSDRG 244
|
| Min. Negotiated Rate |
$14,032.17 |
| Max. Negotiated Rate |
$24,832.88 |
| Rate for Payer: Aetna Medicare |
$14,770.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,463.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,463.39
|
| Rate for Payer: BCBS MAPPO |
$14,770.71
|
| Rate for Payer: BCN Medicare Advantage |
$14,770.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,770.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,770.71
|
| Rate for Payer: Mclaren Medicare |
$14,770.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,509.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,986.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,247.78
|
| Rate for Payer: PACE Medicare |
$14,032.17
|
| Rate for Payer: PACE SWMI |
$14,770.71
|
| Rate for Payer: PHP Commercial |
$16,247.78
|
| Rate for Payer: PHP Medicare Advantage |
$14,770.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$24,832.88
|
| Rate for Payer: Priority Health Medicare |
$14,770.71
|
| Rate for Payer: Priority Health Narrow Network |
$19,866.30
|
| Rate for Payer: Railroad Medicare Medicare |
$14,770.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,770.71
|
| Rate for Payer: UHC Exchange |
$22,894.60
|
| Rate for Payer: UHCCP DNSP |
$14,770.71
|
| Rate for Payer: VA VA |
$14,770.71
|
|
|
PERMETHRIN 5 % TOPICAL CREAM
|
Facility
|
IP
|
$322.35
|
|
|
Service Code
|
NDC 472024260
|
| Hospital Charge Code |
10917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.76 |
| Max. Negotiated Rate |
$322.35 |
| Rate for Payer: Aetna Commercial |
$290.12
|
| Rate for Payer: ASR ASR |
$312.68
|
| Rate for Payer: BCBS Trust/PPO |
$264.71
|
| Rate for Payer: BCN Commercial |
$264.71
|
| Rate for Payer: Cash Price |
$257.88
|
| Rate for Payer: Cofinity Commercial |
$303.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.88
|
| Rate for Payer: Healthscope Commercial |
$312.68
|
| Rate for Payer: Healthscope Whirlpool |
$322.35
|
| Rate for Payer: Mclaren Commercial |
$290.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.00
|
| Rate for Payer: Nomi Health Commercial |
$264.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.67
|
|
|
PERMETHRIN 5 % TOPICAL CREAM
|
Facility
|
OP
|
$97.65
|
|
|
Service Code
|
NDC 45802026937
|
| Hospital Charge Code |
10917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna Medicare |
$36.13
|
| Rate for Payer: ASR ASR |
$94.72
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: BCBS Trust/PPO |
$80.51
|
| Rate for Payer: BCN Commercial |
$80.51
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$91.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$94.72
|
| Rate for Payer: Healthscope Whirlpool |
$97.65
|
| Rate for Payer: Mclaren Commercial |
$87.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Nomi Health Commercial |
$80.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$85.56
|
| Rate for Payer: Priority Health Narrow Network |
$68.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.93
|
|
|
PERMETHRIN 5 % TOPICAL CREAM
|
Facility
|
OP
|
$322.35
|
|
|
Service Code
|
NDC 472024260
|
| Hospital Charge Code |
10917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.27 |
| Max. Negotiated Rate |
$322.35 |
| Rate for Payer: Aetna Commercial |
$290.12
|
| Rate for Payer: Aetna Medicare |
$119.27
|
| Rate for Payer: ASR ASR |
$312.68
|
| Rate for Payer: BCBS Complete |
$128.94
|
| Rate for Payer: BCBS Trust/PPO |
$265.78
|
| Rate for Payer: BCN Commercial |
$265.78
|
| Rate for Payer: Cash Price |
$257.88
|
| Rate for Payer: Cofinity Commercial |
$303.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.88
|
| Rate for Payer: Healthscope Commercial |
$312.68
|
| Rate for Payer: Healthscope Whirlpool |
$322.35
|
| Rate for Payer: Mclaren Commercial |
$290.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.00
|
| Rate for Payer: Nomi Health Commercial |
$264.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$282.44
|
| Rate for Payer: Priority Health Narrow Network |
$225.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.67
|
|
|
PERMETHRIN 5 % TOPICAL CREAM
|
Facility
|
OP
|
$68.88
|
|
|
Service Code
|
NDC 21922002107
|
| Hospital Charge Code |
10917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.49 |
| Max. Negotiated Rate |
$68.88 |
| Rate for Payer: Aetna Commercial |
$61.99
|
| Rate for Payer: Aetna Medicare |
$25.49
|
| Rate for Payer: ASR ASR |
$66.81
|
| Rate for Payer: BCBS Complete |
$27.55
|
| Rate for Payer: BCBS Trust/PPO |
$56.79
|
| Rate for Payer: BCN Commercial |
$56.79
|
| Rate for Payer: Cash Price |
$55.10
|
| Rate for Payer: Cofinity Commercial |
$64.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.10
|
| Rate for Payer: Healthscope Commercial |
$66.81
|
| Rate for Payer: Healthscope Whirlpool |
$68.88
|
| Rate for Payer: Mclaren Commercial |
$61.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.55
|
| Rate for Payer: Nomi Health Commercial |
$56.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$60.35
|
| Rate for Payer: Priority Health Narrow Network |
$48.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.61
|
|
|
PERMETHRIN 5 % TOPICAL CREAM
|
Facility
|
IP
|
$97.65
|
|
|
Service Code
|
NDC 45802026937
|
| Hospital Charge Code |
10917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.24 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: ASR ASR |
$94.72
|
| Rate for Payer: BCBS Trust/PPO |
$80.19
|
| Rate for Payer: BCN Commercial |
$80.19
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$91.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$94.72
|
| Rate for Payer: Healthscope Whirlpool |
$97.65
|
| Rate for Payer: Mclaren Commercial |
$87.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Nomi Health Commercial |
$80.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.93
|
|
|
PERMETHRIN 5 % TOPICAL CREAM
|
Facility
|
IP
|
$68.88
|
|
|
Service Code
|
NDC 21922002107
|
| Hospital Charge Code |
10917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.66 |
| Max. Negotiated Rate |
$68.88 |
| Rate for Payer: Aetna Commercial |
$61.99
|
| Rate for Payer: ASR ASR |
$66.81
|
| Rate for Payer: BCBS Trust/PPO |
$56.56
|
| Rate for Payer: BCN Commercial |
$56.56
|
| Rate for Payer: Cash Price |
$55.10
|
| Rate for Payer: Cofinity Commercial |
$64.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.10
|
| Rate for Payer: Healthscope Commercial |
$66.81
|
| Rate for Payer: Healthscope Whirlpool |
$68.88
|
| Rate for Payer: Mclaren Commercial |
$61.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.55
|
| Rate for Payer: Nomi Health Commercial |
$56.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.61
|
|
|
PERSONALITY DISORDERS
|
Facility
|
IP
|
$7,102.88
|
|
|
Service Code
|
APR-DRG 7523
|
| Min. Negotiated Rate |
$6,421.85 |
| Max. Negotiated Rate |
$7,102.88 |
| Rate for Payer: BCBS Complete |
$7,102.88
|
| Rate for Payer: Mclaren Medicaid |
$6,764.65
|
| Rate for Payer: Meridian Medicaid |
$7,102.88
|
| Rate for Payer: PHP Medicaid |
$6,421.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,764.65
|
| Rate for Payer: UHC Medicaid |
$6,764.65
|
| Rate for Payer: UHCCP Medicaid |
$6,764.65
|
|
|
PERSONALITY DISORDERS
|
Facility
|
IP
|
$15,671.67
|
|
|
Service Code
|
APR-DRG 7524
|
| Min. Negotiated Rate |
$14,169.07 |
| Max. Negotiated Rate |
$15,671.67 |
| Rate for Payer: BCBS Complete |
$15,671.67
|
| Rate for Payer: Mclaren Medicaid |
$14,925.40
|
| Rate for Payer: Meridian Medicaid |
$15,671.67
|
| Rate for Payer: PHP Medicaid |
$14,169.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,925.40
|
| Rate for Payer: UHC Medicaid |
$14,925.40
|
| Rate for Payer: UHCCP Medicaid |
$14,925.40
|
|
|
PERSONALITY DISORDERS
|
Facility
|
IP
|
$3,060.44
|
|
|
Service Code
|
APR-DRG 7522
|
| Min. Negotiated Rate |
$2,767.00 |
| Max. Negotiated Rate |
$3,060.44 |
| Rate for Payer: BCBS Complete |
$3,060.44
|
| Rate for Payer: Mclaren Medicaid |
$2,914.70
|
| Rate for Payer: Meridian Medicaid |
$3,060.44
|
| Rate for Payer: PHP Medicaid |
$2,767.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,914.70
|
| Rate for Payer: UHC Medicaid |
$2,914.70
|
| Rate for Payer: UHCCP Medicaid |
$2,914.70
|
|
|
PERSONALITY DISORDERS
|
Facility
|
IP
|
$2,451.73
|
|
|
Service Code
|
APR-DRG 7521
|
| Min. Negotiated Rate |
$2,216.66 |
| Max. Negotiated Rate |
$2,451.73 |
| Rate for Payer: BCBS Complete |
$2,451.73
|
| Rate for Payer: Mclaren Medicaid |
$2,334.98
|
| Rate for Payer: Meridian Medicaid |
$2,451.73
|
| Rate for Payer: PHP Medicaid |
$2,216.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,334.98
|
| Rate for Payer: UHC Medicaid |
$2,334.98
|
| Rate for Payer: UHCCP Medicaid |
$2,334.98
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
IP
|
$326.80
|
|
|
Service Code
|
NDC 75826011510
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.10 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna Commercial |
$294.12
|
| Rate for Payer: ASR ASR |
$317.00
|
| Rate for Payer: BCBS Trust/PPO |
$268.37
|
| Rate for Payer: BCN Commercial |
$268.37
|
| Rate for Payer: Cash Price |
$261.44
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.44
|
| Rate for Payer: Healthscope Commercial |
$317.00
|
| Rate for Payer: Healthscope Whirlpool |
$326.80
|
| Rate for Payer: Mclaren Commercial |
$294.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.78
|
| Rate for Payer: Nomi Health Commercial |
$267.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.58
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
OP
|
$326.80
|
|
|
Service Code
|
NDC 75826011510
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.92 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna Commercial |
$294.12
|
| Rate for Payer: Aetna Medicare |
$120.92
|
| Rate for Payer: ASR ASR |
$317.00
|
| Rate for Payer: BCBS Complete |
$130.72
|
| Rate for Payer: BCBS Trust/PPO |
$269.45
|
| Rate for Payer: BCN Commercial |
$269.45
|
| Rate for Payer: Cash Price |
$261.44
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.44
|
| Rate for Payer: Healthscope Commercial |
$317.00
|
| Rate for Payer: Healthscope Whirlpool |
$326.80
|
| Rate for Payer: Mclaren Commercial |
$294.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.78
|
| Rate for Payer: Nomi Health Commercial |
$267.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$286.34
|
| Rate for Payer: Priority Health Narrow Network |
$229.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.58
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
OP
|
$318.25
|
|
|
Service Code
|
NDC 42192080201
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.75 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Aetna Commercial |
$286.43
|
| Rate for Payer: Aetna Medicare |
$117.75
|
| Rate for Payer: ASR ASR |
$308.70
|
| Rate for Payer: BCBS Complete |
$127.30
|
| Rate for Payer: BCBS Trust/PPO |
$262.40
|
| Rate for Payer: BCN Commercial |
$262.40
|
| Rate for Payer: Cash Price |
$254.60
|
| Rate for Payer: Cofinity Commercial |
$299.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.60
|
| Rate for Payer: Healthscope Commercial |
$308.70
|
| Rate for Payer: Healthscope Whirlpool |
$318.25
|
| Rate for Payer: Mclaren Commercial |
$286.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.51
|
| Rate for Payer: Nomi Health Commercial |
$260.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$278.85
|
| Rate for Payer: Priority Health Narrow Network |
$223.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$280.06
|
|
|
PHENAZOPYRIDINE 200 MG TABLET
|
Facility
|
OP
|
$422.75
|
|
|
Service Code
|
NDC 65162068210
|
| Hospital Charge Code |
6194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.42 |
| Max. Negotiated Rate |
$422.75 |
| Rate for Payer: Aetna Commercial |
$380.48
|
| Rate for Payer: Aetna Medicare |
$156.42
|
| Rate for Payer: ASR ASR |
$410.07
|
| Rate for Payer: BCBS Complete |
$169.10
|
| Rate for Payer: BCBS Trust/PPO |
$348.56
|
| Rate for Payer: BCN Commercial |
$348.56
|
| Rate for Payer: Cash Price |
$338.20
|
| Rate for Payer: Cofinity Commercial |
$397.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.20
|
| Rate for Payer: Healthscope Commercial |
$410.07
|
| Rate for Payer: Healthscope Whirlpool |
$422.75
|
| Rate for Payer: Mclaren Commercial |
$380.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.34
|
| Rate for Payer: Nomi Health Commercial |
$346.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$370.41
|
| Rate for Payer: Priority Health Narrow Network |
$296.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.02
|
|
