|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$3,576.51
|
|
|
Service Code
|
APR-DRG 7742
|
| Min. Negotiated Rate |
$3,233.59 |
| Max. Negotiated Rate |
$3,576.51 |
| Rate for Payer: BCBS Complete |
$3,576.51
|
| Rate for Payer: Mclaren Medicaid |
$3,406.20
|
| Rate for Payer: Meridian Medicaid |
$3,576.51
|
| Rate for Payer: PHP Medicaid |
$3,233.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,406.20
|
| Rate for Payer: UHC Medicaid |
$3,406.20
|
| Rate for Payer: UHCCP Medicaid |
$3,406.20
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$11,657.03
|
|
|
Service Code
|
APR-DRG 7744
|
| Min. Negotiated Rate |
$10,539.35 |
| Max. Negotiated Rate |
$11,657.03 |
| Rate for Payer: BCBS Complete |
$11,657.03
|
| Rate for Payer: Mclaren Medicaid |
$11,101.93
|
| Rate for Payer: Meridian Medicaid |
$11,657.03
|
| Rate for Payer: PHP Medicaid |
$10,539.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,101.93
|
| Rate for Payer: UHC Medicaid |
$11,101.93
|
| Rate for Payer: UHCCP Medicaid |
$11,101.93
|
|
|
COENZYME Q10 50 MG CAPSULE
|
Facility
|
IP
|
$141.71
|
|
|
Service Code
|
NDC 96295014213
|
| Hospital Charge Code |
35228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.28 |
| Max. Negotiated Rate |
$141.71 |
| Rate for Payer: Aetna Commercial |
$127.53
|
| Rate for Payer: ASR ASR |
$137.45
|
| Rate for Payer: BCBS Trust/PPO |
$116.37
|
| Rate for Payer: BCN Commercial |
$116.37
|
| Rate for Payer: Cash Price |
$113.36
|
| Rate for Payer: Cofinity Commercial |
$133.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.36
|
| Rate for Payer: Healthscope Commercial |
$137.45
|
| Rate for Payer: Healthscope Whirlpool |
$141.71
|
| Rate for Payer: Mclaren Commercial |
$127.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.45
|
| Rate for Payer: Nomi Health Commercial |
$116.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.70
|
|
|
COENZYME Q10 50 MG CAPSULE
|
Facility
|
OP
|
$141.71
|
|
|
Service Code
|
NDC 96295014213
|
| Hospital Charge Code |
35228
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$141.71 |
| Rate for Payer: Aetna Commercial |
$127.53
|
| Rate for Payer: Aetna Medicare |
$52.43
|
| Rate for Payer: ASR ASR |
$137.45
|
| Rate for Payer: BCBS Complete |
$56.68
|
| Rate for Payer: BCBS Trust/PPO |
$116.84
|
| Rate for Payer: BCN Commercial |
$116.84
|
| Rate for Payer: Cash Price |
$113.36
|
| Rate for Payer: Cofinity Commercial |
$133.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.36
|
| Rate for Payer: Healthscope Commercial |
$137.45
|
| Rate for Payer: Healthscope Whirlpool |
$141.71
|
| Rate for Payer: Mclaren Commercial |
$127.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.45
|
| Rate for Payer: Nomi Health Commercial |
$116.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$124.16
|
| Rate for Payer: Priority Health Narrow Network |
$99.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.70
|
|
|
COLCHICINE 0.6 MG CAPSULE
|
Facility
|
OP
|
$543.90
|
|
|
Service Code
|
NDC 904673204
|
| Hospital Charge Code |
172731
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.24 |
| Max. Negotiated Rate |
$543.90 |
| Rate for Payer: Aetna Commercial |
$489.51
|
| Rate for Payer: Aetna Medicare |
$201.24
|
| Rate for Payer: ASR ASR |
$527.58
|
| Rate for Payer: BCBS Complete |
$217.56
|
| Rate for Payer: BCBS Trust/PPO |
$448.45
|
| Rate for Payer: BCN Commercial |
$448.45
|
| Rate for Payer: Cash Price |
$435.12
|
| Rate for Payer: Cofinity Commercial |
$511.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.12
|
| Rate for Payer: Healthscope Commercial |
$527.58
|
| Rate for Payer: Healthscope Whirlpool |
$543.90
|
| Rate for Payer: Mclaren Commercial |
$489.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$435.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$462.31
|
| Rate for Payer: Nomi Health Commercial |
$446.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$407.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$476.57
|
| Rate for Payer: Priority Health Narrow Network |
$381.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$478.63
|
|
|
COLCHICINE 0.6 MG CAPSULE
|
Facility
|
IP
|
$613.50
|
|
|
Service Code
|
NDC 60687035825
|
| Hospital Charge Code |
172731
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$460.12 |
| Max. Negotiated Rate |
$613.50 |
| Rate for Payer: Aetna Commercial |
$552.15
|
| Rate for Payer: ASR ASR |
$595.09
|
| Rate for Payer: BCBS Trust/PPO |
$503.80
|
| Rate for Payer: BCN Commercial |
$503.80
|
| Rate for Payer: Cash Price |
$490.80
|
| Rate for Payer: Cofinity Commercial |
$576.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$490.80
|
| Rate for Payer: Healthscope Commercial |
$595.09
|
| Rate for Payer: Healthscope Whirlpool |
$613.50
|
| Rate for Payer: Mclaren Commercial |
$552.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$521.47
|
| Rate for Payer: Nomi Health Commercial |
$503.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$460.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$539.88
|
|
|
COLCHICINE 0.6 MG CAPSULE
|
Facility
|
OP
|
$613.50
|
|
|
Service Code
|
NDC 60687035825
|
| Hospital Charge Code |
172731
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$226.99 |
| Max. Negotiated Rate |
$613.50 |
| Rate for Payer: Aetna Commercial |
$552.15
|
| Rate for Payer: Aetna Medicare |
$226.99
|
| Rate for Payer: ASR ASR |
$595.09
|
| Rate for Payer: BCBS Complete |
$245.40
|
| Rate for Payer: BCBS Trust/PPO |
$505.83
|
| Rate for Payer: BCN Commercial |
$505.83
|
| Rate for Payer: Cash Price |
$490.80
|
| Rate for Payer: Cofinity Commercial |
$576.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$490.80
|
| Rate for Payer: Healthscope Commercial |
$595.09
|
| Rate for Payer: Healthscope Whirlpool |
$613.50
|
| Rate for Payer: Mclaren Commercial |
$552.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$490.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$521.47
|
| Rate for Payer: Nomi Health Commercial |
$503.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$460.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$537.55
|
| Rate for Payer: Priority Health Narrow Network |
$430.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$539.88
|
|
|
COLCHICINE 0.6 MG CAPSULE
|
Facility
|
OP
|
$20.45
|
|
|
Service Code
|
NDC 60687035895
|
| Hospital Charge Code |
172731
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$20.45 |
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: Aetna Medicare |
$7.57
|
| Rate for Payer: ASR ASR |
$19.84
|
| Rate for Payer: BCBS Complete |
$8.18
|
| Rate for Payer: BCBS Trust/PPO |
$16.86
|
| Rate for Payer: BCN Commercial |
$16.86
|
| Rate for Payer: Cash Price |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$19.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.36
|
| Rate for Payer: Healthscope Commercial |
$19.84
|
| Rate for Payer: Healthscope Whirlpool |
$20.45
|
| Rate for Payer: Mclaren Commercial |
$18.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.38
|
| Rate for Payer: Nomi Health Commercial |
$16.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17.92
|
| Rate for Payer: Priority Health Narrow Network |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.00
|
|
|
COLCHICINE 0.6 MG CAPSULE
|
Facility
|
IP
|
$20.45
|
|
|
Service Code
|
NDC 60687035895
|
| Hospital Charge Code |
172731
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$20.45 |
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: ASR ASR |
$19.84
|
| Rate for Payer: BCBS Trust/PPO |
$16.79
|
| Rate for Payer: BCN Commercial |
$16.79
|
| Rate for Payer: Cash Price |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$19.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.36
|
| Rate for Payer: Healthscope Commercial |
$19.84
|
| Rate for Payer: Healthscope Whirlpool |
$20.45
|
| Rate for Payer: Mclaren Commercial |
$18.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.38
|
| Rate for Payer: Nomi Health Commercial |
$16.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.00
|
|
|
COLCHICINE 0.6 MG CAPSULE
|
Facility
|
IP
|
$543.90
|
|
|
Service Code
|
NDC 904673204
|
| Hospital Charge Code |
172731
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$407.93 |
| Max. Negotiated Rate |
$543.90 |
| Rate for Payer: Aetna Commercial |
$489.51
|
| Rate for Payer: ASR ASR |
$527.58
|
| Rate for Payer: BCBS Trust/PPO |
$446.65
|
| Rate for Payer: BCN Commercial |
$446.65
|
| Rate for Payer: Cash Price |
$435.12
|
| Rate for Payer: Cofinity Commercial |
$511.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.12
|
| Rate for Payer: Healthscope Commercial |
$527.58
|
| Rate for Payer: Healthscope Whirlpool |
$543.90
|
| Rate for Payer: Mclaren Commercial |
$489.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$462.31
|
| Rate for Payer: Nomi Health Commercial |
$446.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$407.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$478.63
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$409.70
|
|
|
Service Code
|
NDC 60687072721
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.59 |
| Max. Negotiated Rate |
$409.70 |
| Rate for Payer: Aetna Commercial |
$368.73
|
| Rate for Payer: Aetna Medicare |
$151.59
|
| Rate for Payer: ASR ASR |
$397.41
|
| Rate for Payer: BCBS Complete |
$163.88
|
| Rate for Payer: BCBS Trust/PPO |
$337.80
|
| Rate for Payer: BCN Commercial |
$337.80
|
| Rate for Payer: Cash Price |
$327.76
|
| Rate for Payer: Cofinity Commercial |
$385.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.76
|
| Rate for Payer: Healthscope Commercial |
$397.41
|
| Rate for Payer: Healthscope Whirlpool |
$409.70
|
| Rate for Payer: Mclaren Commercial |
$368.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.25
|
| Rate for Payer: Nomi Health Commercial |
$335.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$358.98
|
| Rate for Payer: Priority Health Narrow Network |
$287.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$360.54
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$372.41
|
|
|
Service Code
|
NDC 904712004
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.79 |
| Max. Negotiated Rate |
$372.40 |
| Rate for Payer: Aetna Commercial |
$335.16
|
| Rate for Payer: Aetna Medicare |
$137.79
|
| Rate for Payer: ASR ASR |
$361.23
|
| Rate for Payer: BCBS Complete |
$148.96
|
| Rate for Payer: BCBS Trust/PPO |
$307.05
|
| Rate for Payer: BCN Commercial |
$307.05
|
| Rate for Payer: Cash Price |
$297.92
|
| Rate for Payer: Cofinity Commercial |
$350.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.92
|
| Rate for Payer: Healthscope Commercial |
$361.23
|
| Rate for Payer: Healthscope Whirlpool |
$372.40
|
| Rate for Payer: Mclaren Commercial |
$335.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.54
|
| Rate for Payer: Nomi Health Commercial |
$305.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$326.30
|
| Rate for Payer: Priority Health Narrow Network |
$261.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.72
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$13.66
|
|
|
Service Code
|
NDC 60687072711
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$13.66 |
| Rate for Payer: Aetna Commercial |
$12.29
|
| Rate for Payer: Aetna Medicare |
$5.05
|
| Rate for Payer: ASR ASR |
$13.25
|
| Rate for Payer: BCBS Complete |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$11.26
|
| Rate for Payer: BCN Commercial |
$11.26
|
| Rate for Payer: Cash Price |
$10.93
|
| Rate for Payer: Cofinity Commercial |
$12.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.93
|
| Rate for Payer: Healthscope Commercial |
$13.25
|
| Rate for Payer: Healthscope Whirlpool |
$13.66
|
| Rate for Payer: Mclaren Commercial |
$12.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.61
|
| Rate for Payer: Nomi Health Commercial |
$11.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.97
|
| Rate for Payer: Priority Health Narrow Network |
$9.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.02
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$409.70
|
|
|
Service Code
|
NDC 60687072721
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$307.28 |
| Max. Negotiated Rate |
$409.70 |
| Rate for Payer: Aetna Commercial |
$368.73
|
| Rate for Payer: ASR ASR |
$397.41
|
| Rate for Payer: BCBS Trust/PPO |
$336.45
|
| Rate for Payer: BCN Commercial |
$336.45
|
| Rate for Payer: Cash Price |
$327.76
|
| Rate for Payer: Cofinity Commercial |
$385.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.76
|
| Rate for Payer: Healthscope Commercial |
$397.41
|
| Rate for Payer: Healthscope Whirlpool |
$409.70
|
| Rate for Payer: Mclaren Commercial |
$368.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.25
|
| Rate for Payer: Nomi Health Commercial |
$335.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$360.54
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$372.41
|
|
|
Service Code
|
NDC 904712004
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.30 |
| Max. Negotiated Rate |
$372.40 |
| Rate for Payer: Aetna Commercial |
$335.16
|
| Rate for Payer: ASR ASR |
$361.23
|
| Rate for Payer: BCBS Trust/PPO |
$305.82
|
| Rate for Payer: BCN Commercial |
$305.82
|
| Rate for Payer: Cash Price |
$297.92
|
| Rate for Payer: Cofinity Commercial |
$350.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.92
|
| Rate for Payer: Healthscope Commercial |
$361.23
|
| Rate for Payer: Healthscope Whirlpool |
$372.40
|
| Rate for Payer: Mclaren Commercial |
$335.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.54
|
| Rate for Payer: Nomi Health Commercial |
$305.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.72
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$13.66
|
|
|
Service Code
|
NDC 60687072711
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$13.66 |
| Rate for Payer: Aetna Commercial |
$12.29
|
| Rate for Payer: ASR ASR |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$11.22
|
| Rate for Payer: BCN Commercial |
$11.22
|
| Rate for Payer: Cash Price |
$10.93
|
| Rate for Payer: Cofinity Commercial |
$12.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.93
|
| Rate for Payer: Healthscope Commercial |
$13.25
|
| Rate for Payer: Healthscope Whirlpool |
$13.66
|
| Rate for Payer: Mclaren Commercial |
$12.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.61
|
| Rate for Payer: Nomi Health Commercial |
$11.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.02
|
|
|
COLESTIPOL 1 GRAM TABLET
|
Facility
|
OP
|
$383.62
|
|
|
Service Code
|
NDC 115521116
|
| Hospital Charge Code |
13884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.94 |
| Max. Negotiated Rate |
$383.62 |
| Rate for Payer: Aetna Commercial |
$345.25
|
| Rate for Payer: Aetna Medicare |
$141.94
|
| Rate for Payer: ASR ASR |
$372.11
|
| Rate for Payer: BCBS Complete |
$153.45
|
| Rate for Payer: BCBS Trust/PPO |
$316.29
|
| Rate for Payer: BCN Commercial |
$316.29
|
| Rate for Payer: Cash Price |
$306.89
|
| Rate for Payer: Cofinity Commercial |
$360.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.89
|
| Rate for Payer: Healthscope Commercial |
$372.11
|
| Rate for Payer: Healthscope Whirlpool |
$383.62
|
| Rate for Payer: Mclaren Commercial |
$345.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$306.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.07
|
| Rate for Payer: Nomi Health Commercial |
$314.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$336.12
|
| Rate for Payer: Priority Health Narrow Network |
$268.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$337.58
|
|
|
COLESTIPOL 1 GRAM TABLET
|
Facility
|
IP
|
$383.62
|
|
|
Service Code
|
NDC 115521116
|
| Hospital Charge Code |
13884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.71 |
| Max. Negotiated Rate |
$383.62 |
| Rate for Payer: Aetna Commercial |
$345.25
|
| Rate for Payer: ASR ASR |
$372.11
|
| Rate for Payer: BCBS Trust/PPO |
$315.03
|
| Rate for Payer: BCN Commercial |
$315.03
|
| Rate for Payer: Cash Price |
$306.89
|
| Rate for Payer: Cofinity Commercial |
$360.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.89
|
| Rate for Payer: Healthscope Commercial |
$372.11
|
| Rate for Payer: Healthscope Whirlpool |
$383.62
|
| Rate for Payer: Mclaren Commercial |
$345.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.07
|
| Rate for Payer: Nomi Health Commercial |
$314.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$337.58
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$1,137.57
|
|
|
Service Code
|
NDC 50484001030
|
| Hospital Charge Code |
9682
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$420.90 |
| Max. Negotiated Rate |
$1,137.57 |
| Rate for Payer: Aetna Commercial |
$1,023.81
|
| Rate for Payer: Aetna Medicare |
$420.90
|
| Rate for Payer: ASR ASR |
$1,103.44
|
| Rate for Payer: BCBS Complete |
$455.03
|
| Rate for Payer: BCBS Trust/PPO |
$937.93
|
| Rate for Payer: BCN Commercial |
$937.93
|
| Rate for Payer: Cash Price |
$910.06
|
| Rate for Payer: Cofinity Commercial |
$1,069.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.06
|
| Rate for Payer: Healthscope Commercial |
$1,103.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,137.57
|
| Rate for Payer: Mclaren Commercial |
$1,023.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$910.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$966.93
|
| Rate for Payer: Nomi Health Commercial |
$932.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$853.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$996.74
|
| Rate for Payer: Priority Health Narrow Network |
$797.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,001.06
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$1,137.57
|
|
|
Service Code
|
NDC 50484001030
|
| Hospital Charge Code |
9682
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$853.18 |
| Max. Negotiated Rate |
$1,137.57 |
| Rate for Payer: Aetna Commercial |
$1,023.81
|
| Rate for Payer: ASR ASR |
$1,103.44
|
| Rate for Payer: BCBS Trust/PPO |
$934.17
|
| Rate for Payer: BCN Commercial |
$934.17
|
| Rate for Payer: Cash Price |
$910.06
|
| Rate for Payer: Cofinity Commercial |
$1,069.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.06
|
| Rate for Payer: Healthscope Commercial |
$1,103.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,137.57
|
| Rate for Payer: Mclaren Commercial |
$1,023.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$966.93
|
| Rate for Payer: Nomi Health Commercial |
$932.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$853.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,001.06
|
|
|
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$123,781.09
|
|
|
Service Code
|
MSDRG 429
|
| Min. Negotiated Rate |
$63,303.04 |
| Max. Negotiated Rate |
$123,781.09 |
| Rate for Payer: Aetna Medicare |
$66,634.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83,293.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83,293.48
|
| Rate for Payer: BCBS MAPPO |
$66,634.78
|
| Rate for Payer: BCN Medicare Advantage |
$66,634.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66,634.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$66,634.78
|
| Rate for Payer: Mclaren Medicare |
$66,634.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69,966.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76,630.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$73,298.26
|
| Rate for Payer: PACE Medicare |
$63,303.04
|
| Rate for Payer: PACE SWMI |
$66,634.78
|
| Rate for Payer: PHP Commercial |
$73,298.26
|
| Rate for Payer: PHP Medicare Advantage |
$66,634.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$123,781.09
|
| Rate for Payer: Priority Health Medicare |
$66,634.78
|
| Rate for Payer: Priority Health Narrow Network |
$99,024.87
|
| Rate for Payer: Railroad Medicare Medicare |
$66,634.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$66,634.78
|
| Rate for Payer: UHC Exchange |
$103,283.91
|
| Rate for Payer: UHCCP DNSP |
$66,634.78
|
| Rate for Payer: VA VA |
$66,634.78
|
|
|
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC
|
Facility
|
IP
|
$79,233.03
|
|
|
Service Code
|
MSDRG 430
|
| Min. Negotiated Rate |
$41,120.51 |
| Max. Negotiated Rate |
$79,233.03 |
| Rate for Payer: Aetna Medicare |
$43,284.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54,105.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54,105.94
|
| Rate for Payer: BCBS MAPPO |
$43,284.75
|
| Rate for Payer: BCN Medicare Advantage |
$43,284.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43,284.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$43,284.75
|
| Rate for Payer: Mclaren Medicare |
$43,284.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45,448.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49,777.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$47,613.22
|
| Rate for Payer: PACE Medicare |
$41,120.51
|
| Rate for Payer: PACE SWMI |
$43,284.75
|
| Rate for Payer: PHP Commercial |
$47,613.22
|
| Rate for Payer: PHP Medicare Advantage |
$43,284.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$79,233.03
|
| Rate for Payer: Priority Health Medicare |
$43,284.75
|
| Rate for Payer: Priority Health Narrow Network |
$63,386.43
|
| Rate for Payer: Railroad Medicare Medicare |
$43,284.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$43,284.75
|
| Rate for Payer: UHC Exchange |
$67,091.36
|
| Rate for Payer: UHCCP DNSP |
$43,284.75
|
| Rate for Payer: VA VA |
$43,284.75
|
|
|
COMPLEX AORTIC ARCH PROCEDURES
|
Facility
|
IP
|
$155,506.73
|
|
|
Service Code
|
MSDRG 209
|
| Min. Negotiated Rate |
$79,100.70 |
| Max. Negotiated Rate |
$155,506.73 |
| Rate for Payer: Aetna Medicare |
$83,263.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104,079.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104,079.86
|
| Rate for Payer: BCBS MAPPO |
$83,263.89
|
| Rate for Payer: BCN Medicare Advantage |
$83,263.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83,263.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$83,263.89
|
| Rate for Payer: Mclaren Medicare |
$83,263.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87,427.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95,753.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$91,590.28
|
| Rate for Payer: PACE Medicare |
$79,100.70
|
| Rate for Payer: PACE SWMI |
$83,263.89
|
| Rate for Payer: PHP Commercial |
$91,590.28
|
| Rate for Payer: PHP Medicare Advantage |
$83,263.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$155,506.73
|
| Rate for Payer: Priority Health Medicare |
$83,263.89
|
| Rate for Payer: Priority Health Narrow Network |
$124,405.38
|
| Rate for Payer: Railroad Medicare Medicare |
$83,263.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83,263.89
|
| Rate for Payer: UHC Exchange |
$129,059.03
|
| Rate for Payer: UHCCP DNSP |
$83,263.89
|
| Rate for Payer: VA VA |
$83,263.89
|
|
|
COMPLICATED PEPTIC ULCER WITH CC
|
Facility
|
IP
|
$14,885.99
|
|
|
Service Code
|
MSDRG 381
|
| Min. Negotiated Rate |
$9,079.15 |
| Max. Negotiated Rate |
$14,885.99 |
| Rate for Payer: Aetna Medicare |
$9,557.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,946.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,946.25
|
| Rate for Payer: BCBS MAPPO |
$9,557.00
|
| Rate for Payer: BCN Medicare Advantage |
$9,557.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,557.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,557.00
|
| Rate for Payer: Mclaren Medicare |
$9,557.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,034.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,990.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,512.70
|
| Rate for Payer: PACE Medicare |
$9,079.15
|
| Rate for Payer: PACE SWMI |
$9,557.00
|
| Rate for Payer: PHP Commercial |
$10,512.70
|
| Rate for Payer: PHP Medicare Advantage |
$9,557.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,885.99
|
| Rate for Payer: Priority Health Medicare |
$9,557.00
|
| Rate for Payer: Priority Health Narrow Network |
$11,908.79
|
| Rate for Payer: Railroad Medicare Medicare |
$9,557.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,557.00
|
| Rate for Payer: UHC Exchange |
$14,813.35
|
| Rate for Payer: UHCCP DNSP |
$9,557.00
|
| Rate for Payer: VA VA |
$9,557.00
|
|
|
COMPLICATED PEPTIC ULCER WITH MCC
|
Facility
|
IP
|
$26,958.27
|
|
|
Service Code
|
MSDRG 380
|
| Min. Negotiated Rate |
$15,090.50 |
| Max. Negotiated Rate |
$26,958.27 |
| Rate for Payer: Aetna Medicare |
$15,884.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,855.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,855.92
|
| Rate for Payer: BCBS MAPPO |
$15,884.74
|
| Rate for Payer: BCN Medicare Advantage |
$15,884.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,884.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,884.74
|
| Rate for Payer: Mclaren Medicare |
$15,884.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,678.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,267.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,473.21
|
| Rate for Payer: PACE Medicare |
$15,090.50
|
| Rate for Payer: PACE SWMI |
$15,884.74
|
| Rate for Payer: PHP Commercial |
$17,473.21
|
| Rate for Payer: PHP Medicare Advantage |
$15,884.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$26,958.27
|
| Rate for Payer: Priority Health Medicare |
$15,884.74
|
| Rate for Payer: Priority Health Narrow Network |
$21,566.62
|
| Rate for Payer: Railroad Medicare Medicare |
$15,884.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,884.74
|
| Rate for Payer: UHC Exchange |
$24,621.35
|
| Rate for Payer: UHCCP DNSP |
$15,884.74
|
| Rate for Payer: VA VA |
$15,884.74
|
|
