|
DIGESTIVE MALIGNANCY WITH MCC
|
Facility
|
IP
|
$29,383.17
|
|
|
Service Code
|
MSDRG 374
|
| Min. Negotiated Rate |
$16,297.97 |
| Max. Negotiated Rate |
$29,383.17 |
| Rate for Payer: Aetna Medicare |
$17,155.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,444.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,444.70
|
| Rate for Payer: BCBS MAPPO |
$17,155.76
|
| Rate for Payer: BCN Medicare Advantage |
$17,155.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,155.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,155.76
|
| Rate for Payer: Mclaren Medicare |
$17,155.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,013.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,729.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,871.34
|
| Rate for Payer: PACE Medicare |
$16,297.97
|
| Rate for Payer: PACE SWMI |
$17,155.76
|
| Rate for Payer: PHP Commercial |
$18,871.34
|
| Rate for Payer: PHP Medicare Advantage |
$17,155.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29,383.17
|
| Rate for Payer: Priority Health Medicare |
$17,155.76
|
| Rate for Payer: Priority Health Narrow Network |
$23,506.54
|
| Rate for Payer: Railroad Medicare Medicare |
$17,155.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,155.76
|
| Rate for Payer: UHC Exchange |
$26,591.43
|
| Rate for Payer: UHCCP DNSP |
$17,155.76
|
| Rate for Payer: VA VA |
$17,155.76
|
|
|
DIGESTIVE MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$13,036.38
|
|
|
Service Code
|
MSDRG 376
|
| Min. Negotiated Rate |
$7,990.04 |
| Max. Negotiated Rate |
$13,036.38 |
| Rate for Payer: Aetna Medicare |
$8,410.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,513.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,513.21
|
| Rate for Payer: BCBS MAPPO |
$8,410.57
|
| Rate for Payer: BCN Medicare Advantage |
$8,410.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,410.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,410.57
|
| Rate for Payer: Mclaren Medicare |
$8,410.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,831.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,672.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,251.63
|
| Rate for Payer: PACE Medicare |
$7,990.04
|
| Rate for Payer: PACE SWMI |
$8,410.57
|
| Rate for Payer: PHP Commercial |
$9,251.63
|
| Rate for Payer: PHP Medicare Advantage |
$8,410.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12,698.77
|
| Rate for Payer: Priority Health Medicare |
$8,410.57
|
| Rate for Payer: Priority Health Narrow Network |
$10,159.02
|
| Rate for Payer: Railroad Medicare Medicare |
$8,410.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,410.57
|
| Rate for Payer: UHC Exchange |
$13,036.38
|
| Rate for Payer: UHCCP DNSP |
$8,410.57
|
| Rate for Payer: VA VA |
$8,410.57
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
IP
|
$432.00
|
|
|
Service Code
|
NDC 904592161
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$388.80
|
| Rate for Payer: ASR ASR |
$419.04
|
| Rate for Payer: BCBS Trust/PPO |
$354.76
|
| Rate for Payer: BCN Commercial |
$354.76
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cofinity Commercial |
$406.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.60
|
| Rate for Payer: Healthscope Commercial |
$419.04
|
| Rate for Payer: Healthscope Whirlpool |
$432.00
|
| Rate for Payer: Mclaren Commercial |
$388.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.20
|
| Rate for Payer: Nomi Health Commercial |
$354.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$380.16
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
NDC 904592161
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.84 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$388.80
|
| Rate for Payer: Aetna Medicare |
$159.84
|
| Rate for Payer: ASR ASR |
$419.04
|
| Rate for Payer: BCBS Complete |
$172.80
|
| Rate for Payer: BCBS Trust/PPO |
$356.18
|
| Rate for Payer: BCN Commercial |
$356.18
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cofinity Commercial |
$406.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.60
|
| Rate for Payer: Healthscope Commercial |
$419.04
|
| Rate for Payer: Healthscope Whirlpool |
$432.00
|
| Rate for Payer: Mclaren Commercial |
$388.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$345.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.20
|
| Rate for Payer: Nomi Health Commercial |
$354.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$378.52
|
| Rate for Payer: Priority Health Narrow Network |
$302.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$380.16
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
OP
|
$601.92
|
|
|
Service Code
|
NDC 42292000320
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.71 |
| Max. Negotiated Rate |
$601.92 |
| Rate for Payer: Aetna Commercial |
$541.73
|
| Rate for Payer: Aetna Medicare |
$222.71
|
| Rate for Payer: ASR ASR |
$583.86
|
| Rate for Payer: BCBS Complete |
$240.77
|
| Rate for Payer: BCBS Trust/PPO |
$496.28
|
| Rate for Payer: BCN Commercial |
$496.28
|
| Rate for Payer: Cash Price |
$481.54
|
| Rate for Payer: Cofinity Commercial |
$565.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.54
|
| Rate for Payer: Healthscope Commercial |
$583.86
|
| Rate for Payer: Healthscope Whirlpool |
$601.92
|
| Rate for Payer: Mclaren Commercial |
$541.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$481.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.63
|
| Rate for Payer: Nomi Health Commercial |
$493.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$451.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$527.40
|
| Rate for Payer: Priority Health Narrow Network |
$421.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$529.69
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
OP
|
$6.02
|
|
|
Service Code
|
NDC 42292000301
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Aetna Commercial |
$5.42
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: ASR ASR |
$5.84
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS Trust/PPO |
$4.96
|
| Rate for Payer: BCN Commercial |
$4.96
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: Cofinity Commercial |
$5.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.82
|
| Rate for Payer: Healthscope Commercial |
$5.84
|
| Rate for Payer: Healthscope Whirlpool |
$6.02
|
| Rate for Payer: Mclaren Commercial |
$5.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.12
|
| Rate for Payer: Nomi Health Commercial |
$4.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.27
|
| Rate for Payer: Priority Health Narrow Network |
$4.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.30
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
IP
|
$601.92
|
|
|
Service Code
|
NDC 42292000320
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$451.44 |
| Max. Negotiated Rate |
$601.92 |
| Rate for Payer: Aetna Commercial |
$541.73
|
| Rate for Payer: ASR ASR |
$583.86
|
| Rate for Payer: BCBS Trust/PPO |
$494.30
|
| Rate for Payer: BCN Commercial |
$494.30
|
| Rate for Payer: Cash Price |
$481.54
|
| Rate for Payer: Cofinity Commercial |
$565.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.54
|
| Rate for Payer: Healthscope Commercial |
$583.86
|
| Rate for Payer: Healthscope Whirlpool |
$601.92
|
| Rate for Payer: Mclaren Commercial |
$541.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.63
|
| Rate for Payer: Nomi Health Commercial |
$493.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$451.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$529.69
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
IP
|
$6.02
|
|
|
Service Code
|
NDC 42292000301
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Aetna Commercial |
$5.42
|
| Rate for Payer: ASR ASR |
$5.84
|
| Rate for Payer: BCBS Trust/PPO |
$4.94
|
| Rate for Payer: BCN Commercial |
$4.94
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: Cofinity Commercial |
$5.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.82
|
| Rate for Payer: Healthscope Commercial |
$5.84
|
| Rate for Payer: Healthscope Whirlpool |
$6.02
|
| Rate for Payer: Mclaren Commercial |
$5.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.12
|
| Rate for Payer: Nomi Health Commercial |
$4.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.30
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET
|
Facility
|
IP
|
$53.04
|
|
|
Service Code
|
NDC 904592261
|
| Hospital Charge Code |
2445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$53.04 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: ASR ASR |
$51.45
|
| Rate for Payer: BCBS Trust/PPO |
$43.56
|
| Rate for Payer: BCN Commercial |
$43.56
|
| Rate for Payer: Cash Price |
$42.43
|
| Rate for Payer: Cofinity Commercial |
$49.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.43
|
| Rate for Payer: Healthscope Commercial |
$51.45
|
| Rate for Payer: Healthscope Whirlpool |
$53.04
|
| Rate for Payer: Mclaren Commercial |
$47.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.08
|
| Rate for Payer: Nomi Health Commercial |
$43.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.68
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET
|
Facility
|
OP
|
$53.04
|
|
|
Service Code
|
NDC 904592261
|
| Hospital Charge Code |
2445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.62 |
| Max. Negotiated Rate |
$53.04 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Aetna Medicare |
$19.62
|
| Rate for Payer: ASR ASR |
$51.45
|
| Rate for Payer: BCBS Complete |
$21.22
|
| Rate for Payer: BCBS Trust/PPO |
$43.73
|
| Rate for Payer: BCN Commercial |
$43.73
|
| Rate for Payer: Cash Price |
$42.43
|
| Rate for Payer: Cofinity Commercial |
$49.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.43
|
| Rate for Payer: Healthscope Commercial |
$51.45
|
| Rate for Payer: Healthscope Whirlpool |
$53.04
|
| Rate for Payer: Mclaren Commercial |
$47.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.08
|
| Rate for Payer: Nomi Health Commercial |
$43.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.47
|
| Rate for Payer: Priority Health Narrow Network |
$37.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.68
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$21.61
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
108720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Aetna Commercial |
$19.45
|
| Rate for Payer: Aetna Medicare |
$7.99
|
| Rate for Payer: ASR ASR |
$20.96
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: BCBS Trust/PPO |
$17.82
|
| Rate for Payer: BCN Commercial |
$17.82
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$20.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$20.96
|
| Rate for Payer: Healthscope Whirlpool |
$21.61
|
| Rate for Payer: Mclaren Commercial |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Nomi Health Commercial |
$17.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.94
|
| Rate for Payer: Priority Health Narrow Network |
$7.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.02
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$21.61
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
108720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.21 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Aetna Commercial |
$19.45
|
| Rate for Payer: ASR ASR |
$20.96
|
| Rate for Payer: BCBS Trust/PPO |
$17.74
|
| Rate for Payer: BCN Commercial |
$17.74
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$20.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$20.96
|
| Rate for Payer: Healthscope Whirlpool |
$21.61
|
| Rate for Payer: Mclaren Commercial |
$19.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Nomi Health Commercial |
$17.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.02
|
|
|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12,027.13
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
31432
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,702.34 |
| Max. Negotiated Rate |
$12,027.13 |
| Rate for Payer: Aetna Commercial |
$10,824.42
|
| Rate for Payer: Aetna Medicare |
$5,166.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,458.74
|
| Rate for Payer: ASR ASR |
$11,666.32
|
| Rate for Payer: BCBS Complete |
$2,837.71
|
| Rate for Payer: BCBS MAPPO |
$5,166.99
|
| Rate for Payer: BCBS Trust/PPO |
$9,916.37
|
| Rate for Payer: BCN Commercial |
$9,916.37
|
| Rate for Payer: BCN Medicare Advantage |
$5,166.99
|
| Rate for Payer: Cash Price |
$9,621.71
|
| Rate for Payer: Cash Price |
$9,621.71
|
| Rate for Payer: Cofinity Commercial |
$11,305.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,621.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,166.99
|
| Rate for Payer: Healthscope Commercial |
$11,666.32
|
| Rate for Payer: Healthscope Whirlpool |
$12,027.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,166.99
|
| Rate for Payer: Mclaren Commercial |
$10,824.42
|
| Rate for Payer: Mclaren Medicaid |
$5,166.99
|
| Rate for Payer: Mclaren Medicare |
$5,166.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,425.34
|
| Rate for Payer: Meridian Medicaid |
$2,837.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,942.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,683.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,223.06
|
| Rate for Payer: Nomi Health Commercial |
$9,862.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,020.35
|
| Rate for Payer: PACE Medicare |
$4,908.64
|
| Rate for Payer: PACE SWMI |
$5,166.99
|
| Rate for Payer: PHP Commercial |
$5,683.69
|
| Rate for Payer: PHP Medicaid |
$2,769.51
|
| Rate for Payer: PHP Medicare Advantage |
$5,166.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,702.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,361.97
|
| Rate for Payer: Priority Health Medicare |
$5,166.99
|
| Rate for Payer: Priority Health Narrow Network |
$4,289.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,166.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,583.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,166.99
|
| Rate for Payer: UHC Exchange |
$8,008.83
|
| Rate for Payer: UHC Medicaid |
$2,702.34
|
| Rate for Payer: UHCCP DNSP |
$5,166.99
|
| Rate for Payer: UHCCP Medicaid |
$2,702.34
|
| Rate for Payer: VA VA |
$5,166.99
|
|
|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,027.13
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
31432
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,020.35 |
| Max. Negotiated Rate |
$12,027.13 |
| Rate for Payer: Aetna Commercial |
$10,824.42
|
| Rate for Payer: ASR ASR |
$11,666.32
|
| Rate for Payer: BCBS Trust/PPO |
$9,876.68
|
| Rate for Payer: BCN Commercial |
$9,876.68
|
| Rate for Payer: Cash Price |
$9,621.71
|
| Rate for Payer: Cofinity Commercial |
$11,305.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,621.71
|
| Rate for Payer: Healthscope Commercial |
$11,666.32
|
| Rate for Payer: Healthscope Whirlpool |
$12,027.13
|
| Rate for Payer: Mclaren Commercial |
$10,824.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,223.06
|
| Rate for Payer: Nomi Health Commercial |
$9,862.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,020.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,583.88
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$10,032.53
|
|
|
Service Code
|
APR-DRG 5173
|
| Min. Negotiated Rate |
$9,070.61 |
| Max. Negotiated Rate |
$10,032.53 |
| Rate for Payer: BCBS Complete |
$10,032.53
|
| Rate for Payer: Mclaren Medicaid |
$9,554.79
|
| Rate for Payer: Meridian Medicaid |
$10,032.53
|
| Rate for Payer: PHP Medicaid |
$9,070.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,554.79
|
| Rate for Payer: UHC Medicaid |
$9,554.79
|
| Rate for Payer: UHCCP Medicaid |
$9,554.79
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$14,320.20
|
|
|
Service Code
|
APR-DRG 5174
|
| Min. Negotiated Rate |
$12,947.17 |
| Max. Negotiated Rate |
$14,320.20 |
| Rate for Payer: BCBS Complete |
$14,320.20
|
| Rate for Payer: Mclaren Medicaid |
$13,638.28
|
| Rate for Payer: Meridian Medicaid |
$14,320.20
|
| Rate for Payer: PHP Medicaid |
$12,947.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,638.28
|
| Rate for Payer: UHC Medicaid |
$13,638.28
|
| Rate for Payer: UHCCP Medicaid |
$13,638.28
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$5,118.72
|
|
|
Service Code
|
APR-DRG 5171
|
| Min. Negotiated Rate |
$4,627.93 |
| Max. Negotiated Rate |
$5,118.72 |
| Rate for Payer: BCBS Complete |
$5,118.72
|
| Rate for Payer: Mclaren Medicaid |
$4,874.97
|
| Rate for Payer: Meridian Medicaid |
$5,118.72
|
| Rate for Payer: PHP Medicaid |
$4,627.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,874.97
|
| Rate for Payer: UHC Medicaid |
$4,874.97
|
| Rate for Payer: UHCCP Medicaid |
$4,874.97
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$6,358.48
|
|
|
Service Code
|
APR-DRG 5172
|
| Min. Negotiated Rate |
$5,748.82 |
| Max. Negotiated Rate |
$6,358.48 |
| Rate for Payer: BCBS Complete |
$6,358.48
|
| Rate for Payer: Mclaren Medicaid |
$6,055.69
|
| Rate for Payer: Meridian Medicaid |
$6,358.48
|
| Rate for Payer: PHP Medicaid |
$5,748.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,055.69
|
| Rate for Payer: UHC Medicaid |
$6,055.69
|
| Rate for Payer: UHCCP Medicaid |
$6,055.69
|
|
|
DILTIAZEM 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$40.38
|
|
|
Service Code
|
HCPCS J1163
|
| Hospital Charge Code |
22156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$40.38 |
| Rate for Payer: Aetna Commercial |
$36.34
|
| Rate for Payer: ASR ASR |
$39.16
|
| Rate for Payer: BCBS Trust/PPO |
$33.16
|
| Rate for Payer: BCN Commercial |
$33.16
|
| Rate for Payer: Cash Price |
$32.30
|
| Rate for Payer: Cofinity Commercial |
$37.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.30
|
| Rate for Payer: Healthscope Commercial |
$39.16
|
| Rate for Payer: Healthscope Whirlpool |
$40.38
|
| Rate for Payer: Mclaren Commercial |
$36.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.32
|
| Rate for Payer: Nomi Health Commercial |
$33.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.53
|
|
|
DILTIAZEM 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$40.38
|
|
|
Service Code
|
HCPCS J1163
|
| Hospital Charge Code |
22156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$40.38 |
| Rate for Payer: Aetna Commercial |
$36.34
|
| Rate for Payer: Aetna Medicare |
$14.94
|
| Rate for Payer: ASR ASR |
$39.16
|
| Rate for Payer: BCBS Complete |
$16.15
|
| Rate for Payer: BCBS Trust/PPO |
$33.29
|
| Rate for Payer: BCN Commercial |
$33.29
|
| Rate for Payer: Cash Price |
$32.30
|
| Rate for Payer: Cash Price |
$32.30
|
| Rate for Payer: Cofinity Commercial |
$37.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.30
|
| Rate for Payer: Healthscope Commercial |
$39.16
|
| Rate for Payer: Healthscope Whirlpool |
$40.38
|
| Rate for Payer: Mclaren Commercial |
$36.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.32
|
| Rate for Payer: Nomi Health Commercial |
$33.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.53
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$3.74
|
|
|
Service Code
|
NDC 51079074501
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: ASR ASR |
$3.62
|
| Rate for Payer: BCBS Trust/PPO |
$3.07
|
| Rate for Payer: BCN Commercial |
$3.07
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.62
|
| Rate for Payer: Healthscope Whirlpool |
$3.74
|
| Rate for Payer: Mclaren Commercial |
$3.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Nomi Health Commercial |
$3.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.29
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$373.65
|
|
|
Service Code
|
NDC 51079074520
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.24 |
| Max. Negotiated Rate |
$373.65 |
| Rate for Payer: Aetna Commercial |
$336.29
|
| Rate for Payer: ASR ASR |
$362.44
|
| Rate for Payer: BCBS Trust/PPO |
$306.84
|
| Rate for Payer: BCN Commercial |
$306.84
|
| Rate for Payer: Cash Price |
$298.92
|
| Rate for Payer: Cofinity Commercial |
$351.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.92
|
| Rate for Payer: Healthscope Commercial |
$362.44
|
| Rate for Payer: Healthscope Whirlpool |
$373.65
|
| Rate for Payer: Mclaren Commercial |
$336.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: Nomi Health Commercial |
$306.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.81
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$428.45
|
|
|
Service Code
|
NDC 60687071701
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$321.34 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Aetna Commercial |
$385.61
|
| Rate for Payer: ASR ASR |
$415.60
|
| Rate for Payer: BCBS Trust/PPO |
$351.84
|
| Rate for Payer: BCN Commercial |
$351.84
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$402.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$415.60
|
| Rate for Payer: Healthscope Whirlpool |
$428.45
|
| Rate for Payer: Mclaren Commercial |
$385.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Nomi Health Commercial |
$351.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.04
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 93031801
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.99 |
| Max. Negotiated Rate |
$326.65 |
| Rate for Payer: Aetna Commercial |
$293.99
|
| Rate for Payer: ASR ASR |
$316.85
|
| Rate for Payer: BCBS Trust/PPO |
$268.24
|
| Rate for Payer: BCN Commercial |
$268.24
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$307.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$316.85
|
| Rate for Payer: Healthscope Whirlpool |
$326.65
|
| Rate for Payer: Mclaren Commercial |
$293.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Nomi Health Commercial |
$267.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.45
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$3.74
|
|
|
Service Code
|
NDC 51079074501
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: ASR ASR |
$3.62
|
| Rate for Payer: BCBS Complete |
$1.49
|
| Rate for Payer: BCBS Trust/PPO |
$3.08
|
| Rate for Payer: BCN Commercial |
$3.08
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.62
|
| Rate for Payer: Healthscope Whirlpool |
$3.74
|
| Rate for Payer: Mclaren Commercial |
$3.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Nomi Health Commercial |
$3.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.27
|
| Rate for Payer: Priority Health Narrow Network |
$2.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.29
|
|
