|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE
|
Facility
IP
|
$3,894.98
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,726.49 |
| Max. Negotiated Rate |
$3,894.98 |
| Rate for Payer: Aetna Commercial |
$3,505.48
|
| Rate for Payer: ASR ASR |
$3,778.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,019.78
|
| Rate for Payer: BCN Commercial |
$3,019.78
|
| Rate for Payer: Cash Price |
$3,115.98
|
| Rate for Payer: Cofinity Commercial |
$3,661.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,115.98
|
| Rate for Payer: Healthscope Commercial |
$3,894.98
|
| Rate for Payer: Healthscope Whirlpool |
$3,778.13
|
| Rate for Payer: Mclaren Commercial |
$3,505.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,310.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,726.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,427.58
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
IP
|
$352.45
|
|
|
Service Code
|
NDC 0904-6374-61
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.72 |
| Max. Negotiated Rate |
$352.45 |
| Rate for Payer: Aetna Commercial |
$317.20
|
| Rate for Payer: ASR ASR |
$341.88
|
| Rate for Payer: BCBS Trust/PPO |
$273.25
|
| Rate for Payer: BCN Commercial |
$273.25
|
| Rate for Payer: Cash Price |
$281.96
|
| Rate for Payer: Cofinity Commercial |
$331.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.96
|
| Rate for Payer: Healthscope Commercial |
$352.45
|
| Rate for Payer: Healthscope Whirlpool |
$341.88
|
| Rate for Payer: Mclaren Commercial |
$317.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$299.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$310.16
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) CUSTOM INJECTION
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
300612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: ASR ASR |
$17.46
|
| Rate for Payer: BCBS Trust/PPO |
$13.96
|
| Rate for Payer: BCN Commercial |
$13.96
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.40
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Healthscope Whirlpool |
$17.46
|
| Rate for Payer: Mclaren Commercial |
$16.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.84
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION
|
Facility
IP
|
$12.16
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
18192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$12.16 |
| Rate for Payer: Aetna Commercial |
$10.94
|
| Rate for Payer: Aetna Commercial |
$5.76
|
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Commercial |
$131.76
|
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: ASR ASR |
$142.01
|
| Rate for Payer: ASR ASR |
$6.21
|
| Rate for Payer: ASR ASR |
$11.80
|
| Rate for Payer: ASR ASR |
$17.46
|
| Rate for Payer: ASR ASR |
$69.84
|
| Rate for Payer: BCBS Trust/PPO |
$55.82
|
| Rate for Payer: BCBS Trust/PPO |
$9.43
|
| Rate for Payer: BCBS Trust/PPO |
$13.96
|
| Rate for Payer: BCBS Trust/PPO |
$4.96
|
| Rate for Payer: BCBS Trust/PPO |
$113.50
|
| Rate for Payer: BCN Commercial |
$13.96
|
| Rate for Payer: BCN Commercial |
$113.50
|
| Rate for Payer: BCN Commercial |
$55.82
|
| Rate for Payer: BCN Commercial |
$9.43
|
| Rate for Payer: BCN Commercial |
$4.96
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$9.73
|
| Rate for Payer: Cash Price |
$117.12
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Commercial |
$137.62
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Cofinity Commercial |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$11.43
|
| Rate for Payer: Cofinity Commercial |
$6.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.73
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Healthscope Commercial |
$6.40
|
| Rate for Payer: Healthscope Commercial |
$12.16
|
| Rate for Payer: Healthscope Commercial |
$146.40
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Healthscope Whirlpool |
$69.84
|
| Rate for Payer: Healthscope Whirlpool |
$17.46
|
| Rate for Payer: Healthscope Whirlpool |
$142.01
|
| Rate for Payer: Healthscope Whirlpool |
$6.21
|
| Rate for Payer: Healthscope Whirlpool |
$11.80
|
| Rate for Payer: Mclaren Commercial |
$10.94
|
| Rate for Payer: Mclaren Commercial |
$5.76
|
| Rate for Payer: Mclaren Commercial |
$131.76
|
| Rate for Payer: Mclaren Commercial |
$64.80
|
| Rate for Payer: Mclaren Commercial |
$16.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.36
|
|
|
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION
|
Facility
IP
|
$20.56
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
153276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$20.56 |
| Rate for Payer: Aetna Commercial |
$18.50
|
| Rate for Payer: Aetna Commercial |
$22.35
|
| Rate for Payer: ASR ASR |
$24.09
|
| Rate for Payer: ASR ASR |
$19.94
|
| Rate for Payer: BCBS Trust/PPO |
$15.94
|
| Rate for Payer: BCBS Trust/PPO |
$19.25
|
| Rate for Payer: BCN Commercial |
$19.25
|
| Rate for Payer: BCN Commercial |
$15.94
|
| Rate for Payer: Cash Price |
$16.45
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: Cofinity Commercial |
$23.34
|
| Rate for Payer: Cofinity Commercial |
$19.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.86
|
| Rate for Payer: Healthscope Commercial |
$24.83
|
| Rate for Payer: Healthscope Commercial |
$20.56
|
| Rate for Payer: Healthscope Whirlpool |
$24.09
|
| Rate for Payer: Healthscope Whirlpool |
$19.94
|
| Rate for Payer: Mclaren Commercial |
$22.35
|
| Rate for Payer: Mclaren Commercial |
$18.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.85
|
|
|
ROSIGLITAZONE 4 MG TABLET
|
Facility
IP
|
$586.86
|
|
|
Service Code
|
NDC 0173-0863-13
|
| Hospital Charge Code |
25252
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$410.80 |
| Max. Negotiated Rate |
$586.86 |
| Rate for Payer: Aetna Commercial |
$528.17
|
| Rate for Payer: ASR ASR |
$569.25
|
| Rate for Payer: BCBS Trust/PPO |
$454.99
|
| Rate for Payer: BCN Commercial |
$454.99
|
| Rate for Payer: Cash Price |
$469.49
|
| Rate for Payer: Cofinity Commercial |
$551.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$469.49
|
| Rate for Payer: Healthscope Commercial |
$586.86
|
| Rate for Payer: Healthscope Whirlpool |
$569.25
|
| Rate for Payer: Mclaren Commercial |
$528.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$498.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$410.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$516.44
|
|
|
SACCHAROMYCES BOULARDII 250 MG CAPSULE
|
Facility
IP
|
$123.12
|
|
|
Service Code
|
NDC 904723006
|
| Hospital Charge Code |
37343
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.18 |
| Max. Negotiated Rate |
$123.12 |
| Rate for Payer: Aetna Commercial |
$110.81
|
| Rate for Payer: ASR ASR |
$119.43
|
| Rate for Payer: BCBS Trust/PPO |
$95.45
|
| Rate for Payer: BCN Commercial |
$95.45
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cofinity Commercial |
$115.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.50
|
| Rate for Payer: Healthscope Commercial |
$123.12
|
| Rate for Payer: Healthscope Whirlpool |
$119.43
|
| Rate for Payer: Mclaren Commercial |
$110.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.35
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
IP
|
$2,298.59
|
|
|
Service Code
|
NDC 0078-0659-20
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,609.01 |
| Max. Negotiated Rate |
$2,298.59 |
| Rate for Payer: Aetna Commercial |
$2,068.73
|
| Rate for Payer: ASR ASR |
$2,229.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,782.10
|
| Rate for Payer: BCN Commercial |
$1,782.10
|
| Rate for Payer: Cash Price |
$1,838.87
|
| Rate for Payer: Cofinity Commercial |
$2,160.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,838.87
|
| Rate for Payer: Healthscope Commercial |
$2,298.59
|
| Rate for Payer: Healthscope Whirlpool |
$2,229.63
|
| Rate for Payer: Mclaren Commercial |
$2,068.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,953.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,609.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,022.76
|
|
|
SALIVARY GLAND PROCEDURES
|
Facility
IP
|
$15,250.07
|
|
|
Service Code
|
MS-DRG 139
|
| Min. Negotiated Rate |
$11,149.64 |
| Max. Negotiated Rate |
$15,250.07 |
| Rate for Payer: Aetna Medicare |
$11,736.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,670.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,670.58
|
| Rate for Payer: BCBS MAPPO |
$11,736.46
|
| Rate for Payer: BCN Medicare Advantage |
$11,736.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,736.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,736.46
|
| Rate for Payer: Mclaren Medicare |
$11,736.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,323.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,496.93
|
| Rate for Payer: PACE Medicare |
$11,149.64
|
| Rate for Payer: PACE SWMI |
$11,736.46
|
| Rate for Payer: PHP Commercial |
$12,910.11
|
| Rate for Payer: PHP Medicare Advantage |
$11,736.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,250.07
|
| Rate for Payer: Priority Health Medicare |
$11,736.46
|
| Rate for Payer: Priority Health Narrow Network |
$12,200.06
|
| Rate for Payer: Railroad Medicare Medicare |
$11,736.46
|
| Rate for Payer: UHC Medicare Advantage |
$12,088.55
|
| Rate for Payer: VA VA |
$11,736.46
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
IP
|
$109.05
|
|
|
Service Code
|
NDC 50742-505-04
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.34 |
| Max. Negotiated Rate |
$109.05 |
| Rate for Payer: Aetna Commercial |
$98.14
|
| Rate for Payer: ASR ASR |
$105.78
|
| Rate for Payer: BCBS Trust/PPO |
$84.55
|
| Rate for Payer: BCN Commercial |
$84.55
|
| Rate for Payer: Cash Price |
$87.24
|
| Rate for Payer: Cofinity Commercial |
$102.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.24
|
| Rate for Payer: Healthscope Commercial |
$109.05
|
| Rate for Payer: Healthscope Whirlpool |
$105.78
|
| Rate for Payer: Mclaren Commercial |
$98.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.96
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
IP
|
$257.74
|
|
|
Service Code
|
NDC 66758-208-54
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.42 |
| Max. Negotiated Rate |
$257.74 |
| Rate for Payer: Aetna Commercial |
$231.97
|
| Rate for Payer: ASR ASR |
$250.01
|
| Rate for Payer: BCBS Trust/PPO |
$199.83
|
| Rate for Payer: BCN Commercial |
$199.83
|
| Rate for Payer: Cash Price |
$206.19
|
| Rate for Payer: Cofinity Commercial |
$242.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.19
|
| Rate for Payer: Healthscope Commercial |
$257.74
|
| Rate for Payer: Healthscope Whirlpool |
$250.01
|
| Rate for Payer: Mclaren Commercial |
$231.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.81
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
IP
|
$43.80
|
|
|
Service Code
|
NDC 10019-553-90
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.66 |
| Max. Negotiated Rate |
$43.80 |
| Rate for Payer: Aetna Commercial |
$39.42
|
| Rate for Payer: ASR ASR |
$42.49
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$33.96
|
| Rate for Payer: Cash Price |
$35.04
|
| Rate for Payer: Cofinity Commercial |
$41.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.04
|
| Rate for Payer: Healthscope Commercial |
$43.80
|
| Rate for Payer: Healthscope Whirlpool |
$42.49
|
| Rate for Payer: Mclaren Commercial |
$39.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.54
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
IP
|
$438.04
|
|
|
Service Code
|
NDC 10019-553-03
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$306.63 |
| Max. Negotiated Rate |
$438.04 |
| Rate for Payer: Aetna Commercial |
$394.24
|
| Rate for Payer: ASR ASR |
$424.90
|
| Rate for Payer: BCBS Trust/PPO |
$339.61
|
| Rate for Payer: BCN Commercial |
$339.61
|
| Rate for Payer: Cash Price |
$350.43
|
| Rate for Payer: Cofinity Commercial |
$411.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.43
|
| Rate for Payer: Healthscope Commercial |
$438.04
|
| Rate for Payer: Healthscope Whirlpool |
$424.90
|
| Rate for Payer: Mclaren Commercial |
$394.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$372.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$306.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.48
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
IP
|
$188.40
|
|
|
Service Code
|
NDC 0067-4345-09
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.88 |
| Max. Negotiated Rate |
$188.40 |
| Rate for Payer: Aetna Commercial |
$169.56
|
| Rate for Payer: ASR ASR |
$182.75
|
| Rate for Payer: BCBS Trust/PPO |
$146.07
|
| Rate for Payer: BCN Commercial |
$146.07
|
| Rate for Payer: Cash Price |
$150.72
|
| Rate for Payer: Cofinity Commercial |
$177.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.72
|
| Rate for Payer: Healthscope Commercial |
$188.40
|
| Rate for Payer: Healthscope Whirlpool |
$182.75
|
| Rate for Payer: Mclaren Commercial |
$169.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$160.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.79
|
|
|
SCREENING OF A PATIENT
|
Professional
|
$15.00
|
|
|
Service Code
|
HCPCS D0190
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$20.16 |
| Rate for Payer: Aetna Commercial |
$13.35
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.50
|
|
|
SEIZURES WITH MCC
|
Facility
IP
|
$25,455.30
|
|
|
Service Code
|
MS-DRG 100
|
| Min. Negotiated Rate |
$17,542.30 |
| Max. Negotiated Rate |
$25,455.30 |
| Rate for Payer: Aetna Medicare |
$18,465.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,081.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,081.98
|
| Rate for Payer: BCBS MAPPO |
$18,465.58
|
| Rate for Payer: BCN Medicare Advantage |
$18,465.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,465.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,465.58
|
| Rate for Payer: Mclaren Medicare |
$18,465.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,388.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,235.42
|
| Rate for Payer: PACE Medicare |
$17,542.30
|
| Rate for Payer: PACE SWMI |
$18,465.58
|
| Rate for Payer: PHP Commercial |
$20,312.14
|
| Rate for Payer: PHP Medicare Advantage |
$18,465.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,455.30
|
| Rate for Payer: Priority Health Medicare |
$18,465.58
|
| Rate for Payer: Priority Health Narrow Network |
$20,364.24
|
| Rate for Payer: Railroad Medicare Medicare |
$18,465.58
|
| Rate for Payer: UHC Medicare Advantage |
$19,019.55
|
| Rate for Payer: VA VA |
$18,465.58
|
|
|
SEIZURES WITHOUT MCC
|
Facility
IP
|
$11,727.48
|
|
|
Service Code
|
MS-DRG 101
|
| Min. Negotiated Rate |
$8,912.88 |
| Max. Negotiated Rate |
$11,727.48 |
| Rate for Payer: Aetna Medicare |
$9,381.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,727.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,727.48
|
| Rate for Payer: BCBS MAPPO |
$9,381.98
|
| Rate for Payer: BCN Medicare Advantage |
$9,381.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,381.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,381.98
|
| Rate for Payer: Mclaren Medicare |
$9,381.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,851.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,789.28
|
| Rate for Payer: PACE Medicare |
$8,912.88
|
| Rate for Payer: PACE SWMI |
$9,381.98
|
| Rate for Payer: PHP Commercial |
$10,320.18
|
| Rate for Payer: PHP Medicare Advantage |
$9,381.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,679.26
|
| Rate for Payer: Priority Health Medicare |
$9,381.98
|
| Rate for Payer: Priority Health Narrow Network |
$9,343.41
|
| Rate for Payer: Railroad Medicare Medicare |
$9,381.98
|
| Rate for Payer: UHC Medicare Advantage |
$9,663.44
|
| Rate for Payer: VA VA |
$9,381.98
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
IP
|
$119.70
|
|
|
Service Code
|
NDC 49483-080-01
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.79 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna Commercial |
$107.73
|
| Rate for Payer: ASR ASR |
$116.11
|
| Rate for Payer: BCBS Trust/PPO |
$92.80
|
| Rate for Payer: BCN Commercial |
$92.80
|
| Rate for Payer: Cash Price |
$95.76
|
| Rate for Payer: Cofinity Commercial |
$112.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.76
|
| Rate for Payer: Healthscope Commercial |
$119.70
|
| Rate for Payer: Healthscope Whirlpool |
$116.11
|
| Rate for Payer: Mclaren Commercial |
$107.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.34
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
IP
|
$132.00
|
|
|
Service Code
|
NDC 0904-6522-61
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: ASR ASR |
$128.04
|
| Rate for Payer: BCBS Trust/PPO |
$102.34
|
| Rate for Payer: BCN Commercial |
$102.34
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$124.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Healthscope Commercial |
$132.00
|
| Rate for Payer: Healthscope Whirlpool |
$128.04
|
| Rate for Payer: Mclaren Commercial |
$118.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.16
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
NDC 0904-7252-61
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: ASR ASR |
$135.80
|
| Rate for Payer: BCBS Trust/PPO |
$108.54
|
| Rate for Payer: BCN Commercial |
$108.54
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$131.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.00
|
| Rate for Payer: Healthscope Commercial |
$140.00
|
| Rate for Payer: Healthscope Whirlpool |
$135.80
|
| Rate for Payer: Mclaren Commercial |
$126.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.20
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
IP
|
$163.80
|
|
|
Service Code
|
NDC 51645-851-01
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna Commercial |
$147.42
|
| Rate for Payer: ASR ASR |
$158.89
|
| Rate for Payer: BCBS Trust/PPO |
$126.99
|
| Rate for Payer: BCN Commercial |
$126.99
|
| Rate for Payer: Cash Price |
$131.04
|
| Rate for Payer: Cofinity Commercial |
$153.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.04
|
| Rate for Payer: Healthscope Commercial |
$163.80
|
| Rate for Payer: Healthscope Whirlpool |
$158.89
|
| Rate for Payer: Mclaren Commercial |
$147.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.14
|
|
|
SEPTIC ARTHRITIS WITH CC
|
Facility
IP
|
$15,487.61
|
|
|
Service Code
|
MS-DRG 549
|
| Min. Negotiated Rate |
$11,298.45 |
| Max. Negotiated Rate |
$15,487.61 |
| Rate for Payer: Aetna Medicare |
$11,893.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,866.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,866.39
|
| Rate for Payer: BCBS MAPPO |
$11,893.11
|
| Rate for Payer: BCN Medicare Advantage |
$11,893.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,893.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,893.11
|
| Rate for Payer: Mclaren Medicare |
$11,893.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,487.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,677.08
|
| Rate for Payer: PACE Medicare |
$11,298.45
|
| Rate for Payer: PACE SWMI |
$11,893.11
|
| Rate for Payer: PHP Commercial |
$13,082.42
|
| Rate for Payer: PHP Medicare Advantage |
$11,893.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,487.61
|
| Rate for Payer: Priority Health Medicare |
$11,893.11
|
| Rate for Payer: Priority Health Narrow Network |
$12,390.09
|
| Rate for Payer: Railroad Medicare Medicare |
$11,893.11
|
| Rate for Payer: UHC Medicare Advantage |
$12,249.90
|
| Rate for Payer: VA VA |
$11,893.11
|
|
|
SEPTIC ARTHRITIS WITH MCC
|
Facility
IP
|
$25,035.43
|
|
|
Service Code
|
MS-DRG 548
|
| Min. Negotiated Rate |
$17,279.29 |
| Max. Negotiated Rate |
$25,035.43 |
| Rate for Payer: Aetna Medicare |
$18,188.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,735.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,735.91
|
| Rate for Payer: BCBS MAPPO |
$18,188.73
|
| Rate for Payer: BCN Medicare Advantage |
$18,188.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,188.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,188.73
|
| Rate for Payer: Mclaren Medicare |
$18,188.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,098.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,917.04
|
| Rate for Payer: PACE Medicare |
$17,279.29
|
| Rate for Payer: PACE SWMI |
$18,188.73
|
| Rate for Payer: PHP Commercial |
$20,007.60
|
| Rate for Payer: PHP Medicare Advantage |
$18,188.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,035.43
|
| Rate for Payer: Priority Health Medicare |
$18,188.73
|
| Rate for Payer: Priority Health Narrow Network |
$20,028.34
|
| Rate for Payer: Railroad Medicare Medicare |
$18,188.73
|
| Rate for Payer: UHC Medicare Advantage |
$18,734.39
|
| Rate for Payer: VA VA |
$18,188.73
|
|
|
SEPTIC ARTHRITIS WITHOUT CC/MCC
|
Facility
IP
|
$12,086.24
|
|
|
Service Code
|
MS-DRG 550
|
| Min. Negotiated Rate |
$9,185.54 |
| Max. Negotiated Rate |
$12,086.24 |
| Rate for Payer: Aetna Medicare |
$9,668.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,086.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,086.24
|
| Rate for Payer: BCBS MAPPO |
$9,668.99
|
| Rate for Payer: BCN Medicare Advantage |
$9,668.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,668.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,668.99
|
| Rate for Payer: Mclaren Medicare |
$9,668.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,152.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,119.34
|
| Rate for Payer: PACE Medicare |
$9,185.54
|
| Rate for Payer: PACE SWMI |
$9,668.99
|
| Rate for Payer: PHP Commercial |
$10,635.89
|
| Rate for Payer: PHP Medicare Advantage |
$9,668.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,823.07
|
| Rate for Payer: Priority Health Medicare |
$9,668.99
|
| Rate for Payer: Priority Health Narrow Network |
$9,458.46
|
| Rate for Payer: Railroad Medicare Medicare |
$9,668.99
|
| Rate for Payer: UHC Medicare Advantage |
$9,959.06
|
| Rate for Payer: VA VA |
$9,668.99
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS
|
Facility
IP
|
$89,429.32
|
|
|
Service Code
|
MS-DRG 870
|
| Min. Negotiated Rate |
$57,616.11 |
| Max. Negotiated Rate |
$89,429.32 |
| Rate for Payer: BCN Medicare Advantage |
$60,648.54
|
| Rate for Payer: Aetna Medicare |
$60,648.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75,810.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75,810.68
|
| Rate for Payer: BCBS MAPPO |
$60,648.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60,648.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$60,648.54
|
| Rate for Payer: Mclaren Medicare |
$60,648.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$63,680.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69,745.82
|
| Rate for Payer: PACE Medicare |
$57,616.11
|
| Rate for Payer: PACE SWMI |
$60,648.54
|
| Rate for Payer: PHP Commercial |
$66,713.39
|
| Rate for Payer: PHP Medicare Advantage |
$60,648.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89,429.32
|
| Rate for Payer: Priority Health Medicare |
$60,648.54
|
| Rate for Payer: Priority Health Narrow Network |
$71,543.46
|
| Rate for Payer: Railroad Medicare Medicare |
$60,648.54
|
| Rate for Payer: UHC Medicare Advantage |
$62,468.00
|
| Rate for Payer: VA VA |
$60,648.54
|
|
