|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$315.16
|
|
|
Service Code
|
NDC 63323-881-01
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$220.61 |
| Max. Negotiated Rate |
$315.16 |
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: ASR ASR |
$305.71
|
| Rate for Payer: BCBS Trust/PPO |
$244.34
|
| Rate for Payer: BCN Commercial |
$244.34
|
| Rate for Payer: Cash Price |
$252.13
|
| Rate for Payer: Cofinity Commercial |
$296.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.13
|
| Rate for Payer: Healthscope Commercial |
$315.16
|
| Rate for Payer: Healthscope Whirlpool |
$305.71
|
| Rate for Payer: Mclaren Commercial |
$283.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.34
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$111.70
|
|
|
Service Code
|
NDC 63323-170-05
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.19 |
| Max. Negotiated Rate |
$111.70 |
| Rate for Payer: Aetna Commercial |
$100.53
|
| Rate for Payer: ASR ASR |
$108.35
|
| Rate for Payer: BCBS Trust/PPO |
$86.60
|
| Rate for Payer: BCN Commercial |
$86.60
|
| Rate for Payer: Cash Price |
$89.36
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.36
|
| Rate for Payer: Healthscope Commercial |
$111.70
|
| Rate for Payer: Healthscope Whirlpool |
$108.35
|
| Rate for Payer: Mclaren Commercial |
$100.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.30
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$285.80
|
|
|
Service Code
|
NDC 63323-170-15
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$200.06 |
| Max. Negotiated Rate |
$285.80 |
| Rate for Payer: Aetna Commercial |
$257.22
|
| Rate for Payer: ASR ASR |
$277.23
|
| Rate for Payer: BCBS Trust/PPO |
$221.58
|
| Rate for Payer: BCN Commercial |
$221.58
|
| Rate for Payer: Cash Price |
$228.64
|
| Rate for Payer: Cofinity Commercial |
$268.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.64
|
| Rate for Payer: Healthscope Commercial |
$285.80
|
| Rate for Payer: Healthscope Whirlpool |
$277.23
|
| Rate for Payer: Mclaren Commercial |
$257.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.50
|
|
|
SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$246.43
|
|
|
Service Code
|
NDC 0409-7391-82
|
| Hospital Charge Code |
7351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$172.50 |
| Max. Negotiated Rate |
$246.43 |
| Rate for Payer: Aetna Commercial |
$221.79
|
| Rate for Payer: ASR ASR |
$239.04
|
| Rate for Payer: BCBS Trust/PPO |
$191.06
|
| Rate for Payer: BCN Commercial |
$191.06
|
| Rate for Payer: Cash Price |
$197.14
|
| Rate for Payer: Cofinity Commercial |
$231.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.14
|
| Rate for Payer: Healthscope Commercial |
$246.43
|
| Rate for Payer: Healthscope Whirlpool |
$239.04
|
| Rate for Payer: Mclaren Commercial |
$221.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.86
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
IP
|
$31.25
|
|
|
Service Code
|
NDC 0536-7415-51
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$31.25 |
| Rate for Payer: Aetna Commercial |
$28.12
|
| Rate for Payer: ASR ASR |
$30.31
|
| Rate for Payer: BCBS Trust/PPO |
$24.23
|
| Rate for Payer: BCN Commercial |
$24.23
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cofinity Commercial |
$29.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.00
|
| Rate for Payer: Healthscope Commercial |
$31.25
|
| Rate for Payer: Healthscope Whirlpool |
$30.31
|
| Rate for Payer: Mclaren Commercial |
$28.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.50
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
IP
|
$31.25
|
|
|
Service Code
|
NDC 0132-0201-40
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$31.25 |
| Rate for Payer: Aetna Commercial |
$28.12
|
| Rate for Payer: ASR ASR |
$30.31
|
| Rate for Payer: BCBS Trust/PPO |
$24.23
|
| Rate for Payer: BCN Commercial |
$24.23
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cofinity Commercial |
$29.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.00
|
| Rate for Payer: Healthscope Commercial |
$31.25
|
| Rate for Payer: Healthscope Whirlpool |
$30.31
|
| Rate for Payer: Mclaren Commercial |
$28.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.50
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
IP
|
$31.25
|
|
|
Service Code
|
NDC 0904-6320-78
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$31.25 |
| Rate for Payer: Aetna Commercial |
$28.12
|
| Rate for Payer: ASR ASR |
$30.31
|
| Rate for Payer: BCBS Trust/PPO |
$24.23
|
| Rate for Payer: BCN Commercial |
$24.23
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cofinity Commercial |
$29.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.00
|
| Rate for Payer: Healthscope Commercial |
$31.25
|
| Rate for Payer: Healthscope Whirlpool |
$30.31
|
| Rate for Payer: Mclaren Commercial |
$28.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.50
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
IP
|
$15.63
|
|
|
Service Code
|
NDC 9629512751
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$15.63 |
| Rate for Payer: Aetna Commercial |
$14.07
|
| Rate for Payer: ASR ASR |
$15.16
|
| Rate for Payer: BCBS Trust/PPO |
$12.12
|
| Rate for Payer: BCN Commercial |
$12.12
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cofinity Commercial |
$14.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.50
|
| Rate for Payer: Healthscope Commercial |
$15.63
|
| Rate for Payer: Healthscope Whirlpool |
$15.16
|
| Rate for Payer: Mclaren Commercial |
$14.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.75
|
|
|
SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA
|
Facility
IP
|
$37.22
|
|
|
Service Code
|
NDC 0132-0202-20
|
| Hospital Charge Code |
116987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.05 |
| Max. Negotiated Rate |
$37.22 |
| Rate for Payer: Aetna Commercial |
$33.50
|
| Rate for Payer: ASR ASR |
$36.10
|
| Rate for Payer: BCBS Trust/PPO |
$28.86
|
| Rate for Payer: BCN Commercial |
$28.86
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Cofinity Commercial |
$34.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.78
|
| Rate for Payer: Healthscope Commercial |
$37.22
|
| Rate for Payer: Healthscope Whirlpool |
$36.10
|
| Rate for Payer: Mclaren Commercial |
$33.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.75
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION
|
Facility
IP
|
$234.51
|
|
|
Service Code
|
NDC 0574-2002-16
|
| Hospital Charge Code |
27999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.16 |
| Max. Negotiated Rate |
$234.51 |
| Rate for Payer: Aetna Commercial |
$211.06
|
| Rate for Payer: ASR ASR |
$227.47
|
| Rate for Payer: BCBS Trust/PPO |
$181.82
|
| Rate for Payer: BCN Commercial |
$181.82
|
| Rate for Payer: Cash Price |
$187.61
|
| Rate for Payer: Cofinity Commercial |
$220.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.61
|
| Rate for Payer: Healthscope Commercial |
$234.51
|
| Rate for Payer: Healthscope Whirlpool |
$227.47
|
| Rate for Payer: Mclaren Commercial |
$211.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.37
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION
|
Facility
IP
|
$8.66
|
|
|
Service Code
|
NDC 9900-0011-22
|
| Hospital Charge Code |
27999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Aetna Commercial |
$7.79
|
| Rate for Payer: ASR ASR |
$8.40
|
| Rate for Payer: BCBS Trust/PPO |
$6.71
|
| Rate for Payer: BCN Commercial |
$6.71
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cofinity Commercial |
$8.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.93
|
| Rate for Payer: Healthscope Commercial |
$8.66
|
| Rate for Payer: Healthscope Whirlpool |
$8.40
|
| Rate for Payer: Mclaren Commercial |
$7.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.62
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION
|
Facility
IP
|
$77.03
|
|
|
Service Code
|
NDC 46287-006-60
|
| Hospital Charge Code |
27999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.92 |
| Max. Negotiated Rate |
$77.03 |
| Rate for Payer: Aetna Commercial |
$69.33
|
| Rate for Payer: ASR ASR |
$74.72
|
| Rate for Payer: BCBS Trust/PPO |
$59.72
|
| Rate for Payer: BCN Commercial |
$59.72
|
| Rate for Payer: Cash Price |
$61.63
|
| Rate for Payer: Cofinity Commercial |
$72.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.62
|
| Rate for Payer: Healthscope Commercial |
$77.03
|
| Rate for Payer: Healthscope Whirlpool |
$74.72
|
| Rate for Payer: Mclaren Commercial |
$69.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.79
|
|
|
SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION
|
Facility
IP
|
$621.29
|
|
|
Service Code
|
NDC 46287-006-01
|
| Hospital Charge Code |
27999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$434.90 |
| Max. Negotiated Rate |
$621.29 |
| Rate for Payer: Aetna Commercial |
$559.16
|
| Rate for Payer: ASR ASR |
$602.65
|
| Rate for Payer: BCBS Trust/PPO |
$481.69
|
| Rate for Payer: BCN Commercial |
$481.69
|
| Rate for Payer: Cash Price |
$497.03
|
| Rate for Payer: Cofinity Commercial |
$584.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.03
|
| Rate for Payer: Healthscope Commercial |
$621.29
|
| Rate for Payer: Healthscope Whirlpool |
$602.65
|
| Rate for Payer: Mclaren Commercial |
$559.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$528.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$546.74
|
|
|
SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$257.94
|
|
|
Service Code
|
NDC 67457-163-02
|
| Hospital Charge Code |
41793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$180.56 |
| Max. Negotiated Rate |
$257.94 |
| Rate for Payer: Aetna Commercial |
$232.15
|
| Rate for Payer: ASR ASR |
$250.20
|
| Rate for Payer: BCBS Trust/PPO |
$199.98
|
| Rate for Payer: BCN Commercial |
$199.98
|
| Rate for Payer: Cash Price |
$206.35
|
| Rate for Payer: Cofinity Commercial |
$242.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.35
|
| Rate for Payer: Healthscope Commercial |
$257.94
|
| Rate for Payer: Healthscope Whirlpool |
$250.20
|
| Rate for Payer: Mclaren Commercial |
$232.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.99
|
|
|
SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$344.35
|
|
|
Service Code
|
HCPCS J0208
|
| Hospital Charge Code |
7364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$241.04 |
| Max. Negotiated Rate |
$344.35 |
| Rate for Payer: Aetna Commercial |
$309.92
|
| Rate for Payer: ASR ASR |
$334.02
|
| Rate for Payer: BCBS Trust/PPO |
$266.97
|
| Rate for Payer: BCN Commercial |
$266.97
|
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: Cofinity Commercial |
$323.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.48
|
| Rate for Payer: Healthscope Commercial |
$344.35
|
| Rate for Payer: Healthscope Whirlpool |
$334.02
|
| Rate for Payer: Mclaren Commercial |
$309.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.03
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
IP
|
$74.35
|
|
|
Service Code
|
NDC 0310-1110-01
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.04 |
| Max. Negotiated Rate |
$74.35 |
| Rate for Payer: Aetna Commercial |
$66.92
|
| Rate for Payer: ASR ASR |
$72.12
|
| Rate for Payer: BCBS Trust/PPO |
$57.64
|
| Rate for Payer: BCN Commercial |
$57.64
|
| Rate for Payer: Cash Price |
$59.48
|
| Rate for Payer: Cofinity Commercial |
$69.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.48
|
| Rate for Payer: Healthscope Commercial |
$74.35
|
| Rate for Payer: Healthscope Whirlpool |
$72.12
|
| Rate for Payer: Mclaren Commercial |
$66.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.43
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
IP
|
$817.83
|
|
|
Service Code
|
NDC 0310-1110-39
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$572.48 |
| Max. Negotiated Rate |
$817.83 |
| Rate for Payer: Aetna Commercial |
$736.05
|
| Rate for Payer: ASR ASR |
$793.30
|
| Rate for Payer: BCBS Trust/PPO |
$634.06
|
| Rate for Payer: BCN Commercial |
$634.06
|
| Rate for Payer: Cash Price |
$654.26
|
| Rate for Payer: Cofinity Commercial |
$768.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$654.26
|
| Rate for Payer: Healthscope Commercial |
$817.83
|
| Rate for Payer: Healthscope Whirlpool |
$793.30
|
| Rate for Payer: Mclaren Commercial |
$736.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$695.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$572.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$719.69
|
|
|
SOFT TISSUE PROCEDURES WITH CC
|
Facility
IP
|
$22,286.39
|
|
|
Service Code
|
MS-DRG 501
|
| Min. Negotiated Rate |
$15,557.28 |
| Max. Negotiated Rate |
$22,286.39 |
| Rate for Payer: Aetna Medicare |
$16,376.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,470.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,470.10
|
| Rate for Payer: BCBS MAPPO |
$16,376.08
|
| Rate for Payer: BCN Medicare Advantage |
$16,376.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,376.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,376.08
|
| Rate for Payer: Mclaren Medicare |
$16,376.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,194.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,832.49
|
| Rate for Payer: PACE Medicare |
$15,557.28
|
| Rate for Payer: PACE SWMI |
$16,376.08
|
| Rate for Payer: PHP Commercial |
$18,013.69
|
| Rate for Payer: PHP Medicare Advantage |
$16,376.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,286.39
|
| Rate for Payer: Priority Health Medicare |
$16,376.08
|
| Rate for Payer: Priority Health Narrow Network |
$17,829.11
|
| Rate for Payer: Railroad Medicare Medicare |
$16,376.08
|
| Rate for Payer: UHC Medicare Advantage |
$16,867.36
|
| Rate for Payer: VA VA |
$16,376.08
|
|
|
SOFT TISSUE PROCEDURES WITH MCC
|
Facility
IP
|
$41,637.55
|
|
|
Service Code
|
MS-DRG 500
|
| Min. Negotiated Rate |
$27,678.99 |
| Max. Negotiated Rate |
$41,637.55 |
| Rate for Payer: Humana Choice PPO Medicare |
$29,135.78
|
| Rate for Payer: Mclaren Medicare |
$29,135.78
|
| Rate for Payer: Aetna Medicare |
$29,135.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36,419.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36,419.72
|
| Rate for Payer: BCBS MAPPO |
$29,135.78
|
| Rate for Payer: BCN Medicare Advantage |
$29,135.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,135.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30,592.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33,506.15
|
| Rate for Payer: PACE Medicare |
$27,678.99
|
| Rate for Payer: PACE SWMI |
$29,135.78
|
| Rate for Payer: PHP Commercial |
$32,049.36
|
| Rate for Payer: PHP Medicare Advantage |
$29,135.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41,637.55
|
| Rate for Payer: Priority Health Medicare |
$29,135.78
|
| Rate for Payer: Priority Health Narrow Network |
$33,310.04
|
| Rate for Payer: Railroad Medicare Medicare |
$29,135.78
|
| Rate for Payer: UHC Medicare Advantage |
$30,009.85
|
| Rate for Payer: VA VA |
$29,135.78
|
|
|
SOFT TISSUE PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$17,753.87
|
|
|
Service Code
|
MS-DRG 502
|
| Min. Negotiated Rate |
$12,718.06 |
| Max. Negotiated Rate |
$17,753.87 |
| Rate for Payer: Aetna Medicare |
$13,387.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,734.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,734.29
|
| Rate for Payer: BCBS MAPPO |
$13,387.43
|
| Rate for Payer: BCN Medicare Advantage |
$13,387.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,387.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,387.43
|
| Rate for Payer: Mclaren Medicare |
$13,387.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,056.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,395.54
|
| Rate for Payer: PACE Medicare |
$12,718.06
|
| Rate for Payer: PACE SWMI |
$13,387.43
|
| Rate for Payer: PHP Commercial |
$14,726.17
|
| Rate for Payer: PHP Medicare Advantage |
$13,387.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,753.87
|
| Rate for Payer: Priority Health Medicare |
$13,387.43
|
| Rate for Payer: Priority Health Narrow Network |
$14,203.10
|
| Rate for Payer: Railroad Medicare Medicare |
$13,387.43
|
| Rate for Payer: UHC Medicare Advantage |
$13,789.05
|
| Rate for Payer: VA VA |
$13,387.43
|
|
|
SOTALOL 80 MG TABLET
|
Facility
IP
|
$462.24
|
|
|
Service Code
|
NDC 0245-0012-01
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$323.57 |
| Max. Negotiated Rate |
$462.24 |
| Rate for Payer: Aetna Commercial |
$416.02
|
| Rate for Payer: ASR ASR |
$448.37
|
| Rate for Payer: BCBS Trust/PPO |
$358.37
|
| Rate for Payer: BCN Commercial |
$358.37
|
| Rate for Payer: Cash Price |
$369.79
|
| Rate for Payer: Cofinity Commercial |
$434.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$369.79
|
| Rate for Payer: Healthscope Commercial |
$462.24
|
| Rate for Payer: Healthscope Whirlpool |
$448.37
|
| Rate for Payer: Mclaren Commercial |
$416.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$392.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$406.77
|
|
|
SOTALOL 80 MG TABLET
|
Facility
IP
|
$117.50
|
|
|
Service Code
|
NDC 60505-0080-0
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$117.50 |
| Rate for Payer: Aetna Commercial |
$105.75
|
| Rate for Payer: ASR ASR |
$113.98
|
| Rate for Payer: BCBS Trust/PPO |
$91.10
|
| Rate for Payer: BCN Commercial |
$91.10
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Commercial |
$110.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$117.50
|
| Rate for Payer: Healthscope Whirlpool |
$113.98
|
| Rate for Payer: Mclaren Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.40
|
|
|
SOTALOL 80 MG TABLET
|
Facility
IP
|
$4.62
|
|
|
Service Code
|
NDC 0245-0012-89
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna Commercial |
$4.16
|
| Rate for Payer: ASR ASR |
$4.48
|
| Rate for Payer: BCBS Trust/PPO |
$3.58
|
| Rate for Payer: BCN Commercial |
$3.58
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cofinity Commercial |
$4.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.70
|
| Rate for Payer: Healthscope Commercial |
$4.62
|
| Rate for Payer: Healthscope Whirlpool |
$4.48
|
| Rate for Payer: Mclaren Commercial |
$4.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.07
|
|
|
SPINAL DISORDERS AND INJURIES WITH CC/MCC
|
Facility
IP
|
$24,967.38
|
|
|
Service Code
|
MS-DRG 052
|
| Min. Negotiated Rate |
$17,236.66 |
| Max. Negotiated Rate |
$24,967.38 |
| Rate for Payer: Aetna Medicare |
$18,143.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,679.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,679.81
|
| Rate for Payer: BCBS MAPPO |
$18,143.85
|
| Rate for Payer: BCN Medicare Advantage |
$18,143.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,143.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,143.85
|
| Rate for Payer: Mclaren Medicare |
$18,143.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,051.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,865.43
|
| Rate for Payer: PACE Medicare |
$17,236.66
|
| Rate for Payer: PACE SWMI |
$18,143.85
|
| Rate for Payer: PHP Commercial |
$19,958.24
|
| Rate for Payer: PHP Medicare Advantage |
$18,143.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,967.38
|
| Rate for Payer: Priority Health Medicare |
$18,143.85
|
| Rate for Payer: Priority Health Narrow Network |
$19,973.90
|
| Rate for Payer: Railroad Medicare Medicare |
$18,143.85
|
| Rate for Payer: UHC Medicare Advantage |
$18,688.17
|
| Rate for Payer: VA VA |
$18,143.85
|
|
|
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC
|
Facility
IP
|
$12,631.99
|
|
|
Service Code
|
MS-DRG 053
|
| Min. Negotiated Rate |
$9,509.67 |
| Max. Negotiated Rate |
$12,631.99 |
| Rate for Payer: Aetna Medicare |
$10,010.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,512.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,512.72
|
| Rate for Payer: BCBS MAPPO |
$10,010.18
|
| Rate for Payer: BCN Medicare Advantage |
$10,010.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,010.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,010.18
|
| Rate for Payer: Mclaren Medicare |
$10,010.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,510.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,511.71
|
| Rate for Payer: PACE Medicare |
$9,509.67
|
| Rate for Payer: PACE SWMI |
$10,010.18
|
| Rate for Payer: PHP Commercial |
$11,011.20
|
| Rate for Payer: PHP Medicare Advantage |
$10,010.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,631.99
|
| Rate for Payer: Priority Health Medicare |
$10,010.18
|
| Rate for Payer: Priority Health Narrow Network |
$10,105.59
|
| Rate for Payer: Railroad Medicare Medicare |
$10,010.18
|
| Rate for Payer: UHC Medicare Advantage |
$10,310.49
|
| Rate for Payer: VA VA |
$10,010.18
|
|
