|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC
|
Facility
|
IP
|
$12,573.15
|
|
|
Service Code
|
MSDRG 897
|
| Min. Negotiated Rate |
$7,706.12 |
| Max. Negotiated Rate |
$12,573.15 |
| Rate for Payer: Aetna Medicare |
$8,111.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,139.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,139.64
|
| Rate for Payer: BCBS MAPPO |
$8,111.71
|
| Rate for Payer: BCN Medicare Advantage |
$8,111.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,111.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,111.71
|
| Rate for Payer: Mclaren Medicare |
$8,111.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,517.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,328.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,922.88
|
| Rate for Payer: PACE Medicare |
$7,706.12
|
| Rate for Payer: PACE SWMI |
$8,111.71
|
| Rate for Payer: PHP Commercial |
$8,922.88
|
| Rate for Payer: PHP Medicare Advantage |
$8,111.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12,128.61
|
| Rate for Payer: Priority Health Medicare |
$8,111.71
|
| Rate for Payer: Priority Health Narrow Network |
$9,702.89
|
| Rate for Payer: Railroad Medicare Medicare |
$8,111.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,111.71
|
| Rate for Payer: UHC Exchange |
$12,573.15
|
| Rate for Payer: UHCCP DNSP |
$8,111.71
|
| Rate for Payer: VA VA |
$8,111.71
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY
|
Facility
|
IP
|
$19,448.65
|
|
|
Service Code
|
MSDRG 895
|
| Min. Negotiated Rate |
$11,351.11 |
| Max. Negotiated Rate |
$19,448.65 |
| Rate for Payer: Aetna Medicare |
$11,948.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,935.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,935.67
|
| Rate for Payer: BCBS MAPPO |
$11,948.54
|
| Rate for Payer: BCN Medicare Advantage |
$11,948.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,948.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,948.54
|
| Rate for Payer: Mclaren Medicare |
$11,948.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,545.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,740.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,143.39
|
| Rate for Payer: PACE Medicare |
$11,351.11
|
| Rate for Payer: PACE SWMI |
$11,948.54
|
| Rate for Payer: PHP Commercial |
$13,143.39
|
| Rate for Payer: PHP Medicare Advantage |
$11,948.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19,448.65
|
| Rate for Payer: Priority Health Medicare |
$11,948.54
|
| Rate for Payer: Priority Health Narrow Network |
$15,558.92
|
| Rate for Payer: Railroad Medicare Medicare |
$11,948.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,948.54
|
| Rate for Payer: UHC Exchange |
$18,520.24
|
| Rate for Payer: UHCCP DNSP |
$11,948.54
|
| Rate for Payer: VA VA |
$11,948.54
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$13,983.42
|
|
|
Service Code
|
APR-DRG 2804
|
| Min. Negotiated Rate |
$12,642.68 |
| Max. Negotiated Rate |
$13,983.42 |
| Rate for Payer: BCBS Complete |
$13,983.42
|
| Rate for Payer: Mclaren Medicaid |
$13,317.54
|
| Rate for Payer: Meridian Medicaid |
$13,983.42
|
| Rate for Payer: PHP Medicaid |
$12,642.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,317.54
|
| Rate for Payer: UHC Medicaid |
$13,317.54
|
| Rate for Payer: UHCCP Medicaid |
$13,317.54
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$3,243.00
|
|
|
Service Code
|
APR-DRG 2801
|
| Min. Negotiated Rate |
$2,932.06 |
| Max. Negotiated Rate |
$3,243.00 |
| Rate for Payer: BCBS Complete |
$3,243.00
|
| Rate for Payer: Mclaren Medicaid |
$3,088.57
|
| Rate for Payer: Meridian Medicaid |
$3,243.00
|
| Rate for Payer: PHP Medicaid |
$2,932.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,088.57
|
| Rate for Payer: UHC Medicaid |
$3,088.57
|
| Rate for Payer: UHCCP Medicaid |
$3,088.57
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$4,329.08
|
|
|
Service Code
|
APR-DRG 2802
|
| Min. Negotiated Rate |
$3,914.01 |
| Max. Negotiated Rate |
$4,329.08 |
| Rate for Payer: BCBS Complete |
$4,329.08
|
| Rate for Payer: Mclaren Medicaid |
$4,122.94
|
| Rate for Payer: Meridian Medicaid |
$4,329.08
|
| Rate for Payer: PHP Medicaid |
$3,914.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,122.94
|
| Rate for Payer: UHC Medicaid |
$4,122.94
|
| Rate for Payer: UHCCP Medicaid |
$4,122.94
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$5,985.19
|
|
|
Service Code
|
APR-DRG 2803
|
| Min. Negotiated Rate |
$5,411.32 |
| Max. Negotiated Rate |
$5,985.19 |
| Rate for Payer: BCBS Complete |
$5,985.19
|
| Rate for Payer: Mclaren Medicaid |
$5,700.18
|
| Rate for Payer: Meridian Medicaid |
$5,985.19
|
| Rate for Payer: PHP Medicaid |
$5,411.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,700.18
|
| Rate for Payer: UHC Medicaid |
$5,700.18
|
| Rate for Payer: UHCCP Medicaid |
$5,700.18
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$2,189.06
|
|
|
Service Code
|
APR-DRG 8112
|
| Min. Negotiated Rate |
$1,979.18 |
| Max. Negotiated Rate |
$2,189.06 |
| Rate for Payer: BCBS Complete |
$2,189.06
|
| Rate for Payer: Mclaren Medicaid |
$2,084.82
|
| Rate for Payer: Meridian Medicaid |
$2,189.06
|
| Rate for Payer: PHP Medicaid |
$1,979.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,084.82
|
| Rate for Payer: UHC Medicaid |
$2,084.82
|
| Rate for Payer: UHCCP Medicaid |
$2,084.82
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$9,773.68
|
|
|
Service Code
|
APR-DRG 8114
|
| Min. Negotiated Rate |
$8,836.57 |
| Max. Negotiated Rate |
$9,773.68 |
| Rate for Payer: BCBS Complete |
$9,773.68
|
| Rate for Payer: Mclaren Medicaid |
$9,308.26
|
| Rate for Payer: Meridian Medicaid |
$9,773.68
|
| Rate for Payer: PHP Medicaid |
$8,836.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,308.26
|
| Rate for Payer: UHC Medicaid |
$9,308.26
|
| Rate for Payer: UHCCP Medicaid |
$9,308.26
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$4,858.77
|
|
|
Service Code
|
APR-DRG 8113
|
| Min. Negotiated Rate |
$4,392.91 |
| Max. Negotiated Rate |
$4,858.77 |
| Rate for Payer: BCBS Complete |
$4,858.77
|
| Rate for Payer: Mclaren Medicaid |
$4,627.40
|
| Rate for Payer: Meridian Medicaid |
$4,858.77
|
| Rate for Payer: PHP Medicaid |
$4,392.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,627.40
|
| Rate for Payer: UHC Medicaid |
$4,627.40
|
| Rate for Payer: UHCCP Medicaid |
$4,627.40
|
|
|
ALLERGIC REACTIONS
|
Facility
|
IP
|
$1,516.60
|
|
|
Service Code
|
APR-DRG 8111
|
| Min. Negotiated Rate |
$1,371.18 |
| Max. Negotiated Rate |
$1,516.60 |
| Rate for Payer: BCBS Complete |
$1,516.60
|
| Rate for Payer: Mclaren Medicaid |
$1,444.38
|
| Rate for Payer: Meridian Medicaid |
$1,516.60
|
| Rate for Payer: PHP Medicaid |
$1,371.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,444.38
|
| Rate for Payer: UHC Medicaid |
$1,444.38
|
| Rate for Payer: UHCCP Medicaid |
$1,444.38
|
|
|
ALLERGIC REACTIONS WITH MCC
|
Facility
|
IP
|
$23,103.17
|
|
|
Service Code
|
MSDRG 915
|
| Min. Negotiated Rate |
$13,170.87 |
| Max. Negotiated Rate |
$23,103.17 |
| Rate for Payer: Aetna Medicare |
$13,864.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,330.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,330.09
|
| Rate for Payer: BCBS MAPPO |
$13,864.07
|
| Rate for Payer: BCN Medicare Advantage |
$13,864.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,864.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,864.07
|
| Rate for Payer: Mclaren Medicare |
$13,864.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,557.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,943.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,250.48
|
| Rate for Payer: PACE Medicare |
$13,170.87
|
| Rate for Payer: PACE SWMI |
$13,864.07
|
| Rate for Payer: PHP Commercial |
$15,250.48
|
| Rate for Payer: PHP Medicare Advantage |
$13,864.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23,103.17
|
| Rate for Payer: Priority Health Medicare |
$13,864.07
|
| Rate for Payer: Priority Health Narrow Network |
$18,482.53
|
| Rate for Payer: Railroad Medicare Medicare |
$13,864.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,864.07
|
| Rate for Payer: UHC Exchange |
$21,489.31
|
| Rate for Payer: UHCCP DNSP |
$13,864.07
|
| Rate for Payer: VA VA |
$13,864.07
|
|
|
ALLERGIC REACTIONS WITHOUT MCC
|
Facility
|
IP
|
$10,156.59
|
|
|
Service Code
|
MSDRG 916
|
| Min. Negotiated Rate |
$6,225.01 |
| Max. Negotiated Rate |
$10,156.59 |
| Rate for Payer: Aetna Medicare |
$6,552.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,190.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,190.80
|
| Rate for Payer: BCBS MAPPO |
$6,552.64
|
| Rate for Payer: BCN Medicare Advantage |
$6,552.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,552.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,552.64
|
| Rate for Payer: Mclaren Medicare |
$6,552.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,880.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,535.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,207.90
|
| Rate for Payer: PACE Medicare |
$6,225.01
|
| Rate for Payer: PACE SWMI |
$6,552.64
|
| Rate for Payer: PHP Commercial |
$7,207.90
|
| Rate for Payer: PHP Medicare Advantage |
$6,552.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9,154.16
|
| Rate for Payer: Priority Health Medicare |
$6,552.64
|
| Rate for Payer: Priority Health Narrow Network |
$7,323.33
|
| Rate for Payer: Railroad Medicare Medicare |
$6,552.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,552.64
|
| Rate for Payer: UHC Exchange |
$10,156.59
|
| Rate for Payer: UHCCP DNSP |
$6,552.64
|
| Rate for Payer: VA VA |
$6,552.64
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$128,507.38
|
|
|
Service Code
|
APR-DRG 0074
|
| Min. Negotiated Rate |
$116,186.05 |
| Max. Negotiated Rate |
$128,507.38 |
| Rate for Payer: BCBS Complete |
$128,507.38
|
| Rate for Payer: Mclaren Medicaid |
$122,387.99
|
| Rate for Payer: Meridian Medicaid |
$128,507.38
|
| Rate for Payer: PHP Medicaid |
$116,186.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$122,387.99
|
| Rate for Payer: UHC Medicaid |
$122,387.99
|
| Rate for Payer: UHCCP Medicaid |
$122,387.99
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$165,111.52
|
|
|
Service Code
|
MSDRG 014
|
| Min. Negotiated Rate |
$83,883.38 |
| Max. Negotiated Rate |
$165,111.52 |
| Rate for Payer: Aetna Medicare |
$88,298.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110,372.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110,372.86
|
| Rate for Payer: BCBS MAPPO |
$88,298.29
|
| Rate for Payer: BCN Medicare Advantage |
$88,298.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88,298.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$88,298.29
|
| Rate for Payer: Mclaren Medicare |
$88,298.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92,713.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101,543.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$97,128.12
|
| Rate for Payer: PACE Medicare |
$83,883.38
|
| Rate for Payer: PACE SWMI |
$88,298.29
|
| Rate for Payer: PHP Commercial |
$97,128.12
|
| Rate for Payer: PHP Medicare Advantage |
$88,298.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$165,111.52
|
| Rate for Payer: Priority Health Medicare |
$88,298.29
|
| Rate for Payer: Priority Health Narrow Network |
$132,089.22
|
| Rate for Payer: Railroad Medicare Medicare |
$88,298.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$88,298.29
|
| Rate for Payer: UHC Exchange |
$136,862.35
|
| Rate for Payer: UHCCP DNSP |
$88,298.29
|
| Rate for Payer: VA VA |
$88,298.29
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$61,268.18
|
|
|
Service Code
|
APR-DRG 0073
|
| Min. Negotiated Rate |
$55,393.77 |
| Max. Negotiated Rate |
$61,268.18 |
| Rate for Payer: BCBS Complete |
$61,268.18
|
| Rate for Payer: Mclaren Medicaid |
$58,350.65
|
| Rate for Payer: Meridian Medicaid |
$61,268.18
|
| Rate for Payer: PHP Medicaid |
$55,393.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$58,350.65
|
| Rate for Payer: UHC Medicaid |
$58,350.65
|
| Rate for Payer: UHCCP Medicaid |
$58,350.65
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$58,866.04
|
|
|
Service Code
|
APR-DRG 0072
|
| Min. Negotiated Rate |
$53,221.95 |
| Max. Negotiated Rate |
$58,866.04 |
| Rate for Payer: BCBS Complete |
$58,866.04
|
| Rate for Payer: Mclaren Medicaid |
$56,062.90
|
| Rate for Payer: Meridian Medicaid |
$58,866.04
|
| Rate for Payer: PHP Medicaid |
$53,221.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$56,062.90
|
| Rate for Payer: UHC Medicaid |
$56,062.90
|
| Rate for Payer: UHCCP Medicaid |
$56,062.90
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$50,455.29
|
|
|
Service Code
|
APR-DRG 0071
|
| Min. Negotiated Rate |
$45,617.61 |
| Max. Negotiated Rate |
$50,455.29 |
| Rate for Payer: BCBS Complete |
$50,455.29
|
| Rate for Payer: Mclaren Medicaid |
$48,052.65
|
| Rate for Payer: Meridian Medicaid |
$50,455.29
|
| Rate for Payer: PHP Medicaid |
$45,617.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$48,052.65
|
| Rate for Payer: UHC Medicaid |
$48,052.65
|
| Rate for Payer: UHCCP Medicaid |
$48,052.65
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
NDC 60687067711
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: ASR ASR |
$2.09
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$1.78
|
| Rate for Payer: BCN Commercial |
$1.78
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$2.09
|
| Rate for Payer: Healthscope Whirlpool |
$2.16
|
| Rate for Payer: Mclaren Commercial |
$1.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.83
|
| Rate for Payer: Nomi Health Commercial |
$1.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.89
|
| Rate for Payer: Priority Health Narrow Network |
$1.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.90
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
NDC 60687067711
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: ASR ASR |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$1.77
|
| Rate for Payer: BCN Commercial |
$1.77
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$2.09
|
| Rate for Payer: Healthscope Whirlpool |
$2.16
|
| Rate for Payer: Mclaren Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.83
|
| Rate for Payer: Nomi Health Commercial |
$1.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.90
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 60687067701
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.74 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Aetna Commercial |
$194.09
|
| Rate for Payer: ASR ASR |
$209.18
|
| Rate for Payer: BCBS Trust/PPO |
$177.09
|
| Rate for Payer: BCN Commercial |
$177.09
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$202.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$209.18
|
| Rate for Payer: Healthscope Whirlpool |
$215.65
|
| Rate for Payer: Mclaren Commercial |
$194.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$176.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.77
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$2.56
|
|
|
Service Code
|
NDC 51079020501
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: ASR ASR |
$2.48
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.48
|
| Rate for Payer: Healthscope Whirlpool |
$2.56
|
| Rate for Payer: Mclaren Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.17
|
| Rate for Payer: Nomi Health Commercial |
$2.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.25
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 60687067701
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Aetna Commercial |
$194.09
|
| Rate for Payer: Aetna Medicare |
$79.79
|
| Rate for Payer: ASR ASR |
$209.18
|
| Rate for Payer: BCBS Complete |
$86.26
|
| Rate for Payer: BCBS Trust/PPO |
$177.80
|
| Rate for Payer: BCN Commercial |
$177.80
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$202.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$209.18
|
| Rate for Payer: Healthscope Whirlpool |
$215.65
|
| Rate for Payer: Mclaren Commercial |
$194.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$176.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$188.95
|
| Rate for Payer: Priority Health Narrow Network |
$151.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.77
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$195.70
|
|
|
Service Code
|
NDC 904704161
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.41 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Aetna Commercial |
$176.13
|
| Rate for Payer: Aetna Medicare |
$72.41
|
| Rate for Payer: ASR ASR |
$189.83
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: BCBS Trust/PPO |
$161.35
|
| Rate for Payer: BCN Commercial |
$161.35
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$183.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$189.83
|
| Rate for Payer: Healthscope Whirlpool |
$195.70
|
| Rate for Payer: Mclaren Commercial |
$176.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: Nomi Health Commercial |
$160.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$171.47
|
| Rate for Payer: Priority Health Narrow Network |
$137.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.22
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$195.70
|
|
|
Service Code
|
NDC 904704161
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.78 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Aetna Commercial |
$176.13
|
| Rate for Payer: ASR ASR |
$189.83
|
| Rate for Payer: BCBS Trust/PPO |
$160.71
|
| Rate for Payer: BCN Commercial |
$160.71
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$183.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$189.83
|
| Rate for Payer: Healthscope Whirlpool |
$195.70
|
| Rate for Payer: Mclaren Commercial |
$176.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: Nomi Health Commercial |
$160.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.22
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$2.56
|
|
|
Service Code
|
NDC 51079020501
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: Aetna Medicare |
$0.95
|
| Rate for Payer: ASR ASR |
$2.48
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$2.11
|
| Rate for Payer: BCN Commercial |
$2.11
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.48
|
| Rate for Payer: Healthscope Whirlpool |
$2.56
|
| Rate for Payer: Mclaren Commercial |
$2.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.17
|
| Rate for Payer: Nomi Health Commercial |
$2.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.24
|
| Rate for Payer: Priority Health Narrow Network |
$1.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.25
|
|
