|
PULMONARY EDEMA AND RESPIRATORY FAILURE
|
Facility
|
IP
|
$16,972.91
|
|
|
Service Code
|
MSDRG 189
|
| Min. Negotiated Rate |
$10,118.33 |
| Max. Negotiated Rate |
$16,972.91 |
| Rate for Payer: Aetna Medicare |
$10,650.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,313.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,313.59
|
| Rate for Payer: BCBS MAPPO |
$10,650.87
|
| Rate for Payer: BCN Medicare Advantage |
$10,650.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,650.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,650.87
|
| Rate for Payer: Mclaren Medicare |
$10,650.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,183.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,248.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,715.96
|
| Rate for Payer: PACE Medicare |
$10,118.33
|
| Rate for Payer: PACE SWMI |
$10,650.87
|
| Rate for Payer: PHP Commercial |
$11,715.96
|
| Rate for Payer: PHP Medicare Advantage |
$10,650.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16,972.91
|
| Rate for Payer: Priority Health Medicare |
$10,650.87
|
| Rate for Payer: Priority Health Narrow Network |
$13,578.33
|
| Rate for Payer: Railroad Medicare Medicare |
$10,650.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,650.87
|
| Rate for Payer: UHC Exchange |
$16,508.85
|
| Rate for Payer: UHCCP DNSP |
$10,650.87
|
| Rate for Payer: VA VA |
$10,650.87
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$3,244.09
|
|
|
Service Code
|
APR-DRG 1341
|
| Min. Negotiated Rate |
$2,933.04 |
| Max. Negotiated Rate |
$3,244.09 |
| Rate for Payer: BCBS Complete |
$3,244.09
|
| Rate for Payer: Mclaren Medicaid |
$3,089.61
|
| Rate for Payer: Meridian Medicaid |
$3,244.09
|
| Rate for Payer: PHP Medicaid |
$2,933.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,089.61
|
| Rate for Payer: UHC Medicaid |
$3,089.61
|
| Rate for Payer: UHCCP Medicaid |
$3,089.61
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$4,101.84
|
|
|
Service Code
|
APR-DRG 1342
|
| Min. Negotiated Rate |
$3,708.55 |
| Max. Negotiated Rate |
$4,101.84 |
| Rate for Payer: BCBS Complete |
$4,101.84
|
| Rate for Payer: Mclaren Medicaid |
$3,906.51
|
| Rate for Payer: Meridian Medicaid |
$4,101.84
|
| Rate for Payer: PHP Medicaid |
$3,708.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,906.51
|
| Rate for Payer: UHC Medicaid |
$3,906.51
|
| Rate for Payer: UHCCP Medicaid |
$3,906.51
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$10,750.77
|
|
|
Service Code
|
APR-DRG 1344
|
| Min. Negotiated Rate |
$9,719.99 |
| Max. Negotiated Rate |
$10,750.77 |
| Rate for Payer: BCBS Complete |
$10,750.77
|
| Rate for Payer: Mclaren Medicaid |
$10,238.83
|
| Rate for Payer: Meridian Medicaid |
$10,750.77
|
| Rate for Payer: PHP Medicaid |
$9,719.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,238.83
|
| Rate for Payer: UHC Medicaid |
$10,238.83
|
| Rate for Payer: UHCCP Medicaid |
$10,238.83
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$6,481.64
|
|
|
Service Code
|
APR-DRG 1343
|
| Min. Negotiated Rate |
$5,860.17 |
| Max. Negotiated Rate |
$6,481.64 |
| Rate for Payer: BCBS Complete |
$6,481.64
|
| Rate for Payer: Mclaren Medicaid |
$6,172.99
|
| Rate for Payer: Meridian Medicaid |
$6,481.64
|
| Rate for Payer: PHP Medicaid |
$5,860.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,172.99
|
| Rate for Payer: UHC Medicaid |
$6,172.99
|
| Rate for Payer: UHCCP Medicaid |
$6,172.99
|
|
|
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE
|
Facility
|
IP
|
$18,871.62
|
|
|
Service Code
|
MSDRG 175
|
| Min. Negotiated Rate |
$11,063.78 |
| Max. Negotiated Rate |
$18,871.62 |
| Rate for Payer: Aetna Medicare |
$11,646.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,557.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,557.60
|
| Rate for Payer: BCBS MAPPO |
$11,646.08
|
| Rate for Payer: BCN Medicare Advantage |
$11,646.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,646.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,646.08
|
| Rate for Payer: Mclaren Medicare |
$11,646.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,228.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,392.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,810.69
|
| Rate for Payer: PACE Medicare |
$11,063.78
|
| Rate for Payer: PACE SWMI |
$11,646.08
|
| Rate for Payer: PHP Commercial |
$12,810.69
|
| Rate for Payer: PHP Medicare Advantage |
$11,646.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18,871.62
|
| Rate for Payer: Priority Health Medicare |
$11,646.08
|
| Rate for Payer: Priority Health Narrow Network |
$15,097.29
|
| Rate for Payer: Railroad Medicare Medicare |
$11,646.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,646.08
|
| Rate for Payer: UHC Exchange |
$18,051.42
|
| Rate for Payer: UHCCP DNSP |
$11,646.08
|
| Rate for Payer: VA VA |
$11,646.08
|
|
|
PULMONARY EMBOLISM WITHOUT MCC
|
Facility
|
IP
|
$11,704.76
|
|
|
Service Code
|
MSDRG 176
|
| Min. Negotiated Rate |
$7,173.89 |
| Max. Negotiated Rate |
$11,704.76 |
| Rate for Payer: Aetna Medicare |
$7,551.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,439.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,439.33
|
| Rate for Payer: BCBS MAPPO |
$7,551.46
|
| Rate for Payer: BCN Medicare Advantage |
$7,551.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,551.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,551.46
|
| Rate for Payer: Mclaren Medicare |
$7,551.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,929.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,684.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,306.61
|
| Rate for Payer: PACE Medicare |
$7,173.89
|
| Rate for Payer: PACE SWMI |
$7,551.46
|
| Rate for Payer: PHP Commercial |
$8,306.61
|
| Rate for Payer: PHP Medicare Advantage |
$7,551.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,059.73
|
| Rate for Payer: Priority Health Medicare |
$7,551.46
|
| Rate for Payer: Priority Health Narrow Network |
$8,847.79
|
| Rate for Payer: Railroad Medicare Medicare |
$7,551.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,551.46
|
| Rate for Payer: UHC Exchange |
$11,704.76
|
| Rate for Payer: UHCCP DNSP |
$7,551.46
|
| Rate for Payer: VA VA |
$7,551.46
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$50.16
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
6744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$50.16 |
| Rate for Payer: Aetna Commercial |
$45.14
|
| Rate for Payer: Aetna Medicare |
$18.56
|
| Rate for Payer: ASR ASR |
$48.66
|
| Rate for Payer: BCBS Complete |
$20.06
|
| Rate for Payer: BCBS Trust/PPO |
$41.36
|
| Rate for Payer: BCN Commercial |
$41.36
|
| Rate for Payer: Cash Price |
$40.13
|
| Rate for Payer: Cash Price |
$40.13
|
| Rate for Payer: Cofinity Commercial |
$47.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.13
|
| Rate for Payer: Healthscope Commercial |
$48.66
|
| Rate for Payer: Healthscope Whirlpool |
$50.16
|
| Rate for Payer: Mclaren Commercial |
$45.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.64
|
| Rate for Payer: Nomi Health Commercial |
$41.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.14
|
| Rate for Payer: Priority Health Narrow Network |
$12.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.14
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$50.16
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
6744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.62 |
| Max. Negotiated Rate |
$50.16 |
| Rate for Payer: Aetna Commercial |
$45.14
|
| Rate for Payer: ASR ASR |
$48.66
|
| Rate for Payer: BCBS Trust/PPO |
$41.19
|
| Rate for Payer: BCN Commercial |
$41.19
|
| Rate for Payer: Cash Price |
$40.13
|
| Rate for Payer: Cofinity Commercial |
$47.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.13
|
| Rate for Payer: Healthscope Commercial |
$48.66
|
| Rate for Payer: Healthscope Whirlpool |
$50.16
|
| Rate for Payer: Mclaren Commercial |
$45.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.64
|
| Rate for Payer: Nomi Health Commercial |
$41.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.14
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 77333094025
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna Commercial |
$1.30
|
| Rate for Payer: Aetna Medicare |
$0.53
|
| Rate for Payer: ASR ASR |
$1.40
|
| Rate for Payer: BCBS Complete |
$0.58
|
| Rate for Payer: BCBS Trust/PPO |
$1.19
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Cofinity Commercial |
$1.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.15
|
| Rate for Payer: Healthscope Commercial |
$1.40
|
| Rate for Payer: Healthscope Whirlpool |
$1.44
|
| Rate for Payer: Mclaren Commercial |
$1.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.22
|
| Rate for Payer: Nomi Health Commercial |
$1.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.26
|
| Rate for Payer: Priority Health Narrow Network |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.27
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$75.95
|
|
|
Service Code
|
NDC 50268085815
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.10 |
| Max. Negotiated Rate |
$75.95 |
| Rate for Payer: Aetna Commercial |
$68.36
|
| Rate for Payer: Aetna Medicare |
$28.10
|
| Rate for Payer: ASR ASR |
$73.67
|
| Rate for Payer: BCBS Complete |
$30.38
|
| Rate for Payer: BCBS Trust/PPO |
$62.62
|
| Rate for Payer: BCN Commercial |
$62.62
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$71.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$73.67
|
| Rate for Payer: Healthscope Whirlpool |
$75.95
|
| Rate for Payer: Mclaren Commercial |
$68.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$66.55
|
| Rate for Payer: Priority Health Narrow Network |
$53.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.84
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$1.52
|
|
|
Service Code
|
NDC 50268085811
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna Commercial |
$1.37
|
| Rate for Payer: ASR ASR |
$1.47
|
| Rate for Payer: BCBS Trust/PPO |
$1.25
|
| Rate for Payer: BCN Commercial |
$1.25
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cofinity Commercial |
$1.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.22
|
| Rate for Payer: Healthscope Commercial |
$1.47
|
| Rate for Payer: Healthscope Whirlpool |
$1.52
|
| Rate for Payer: Mclaren Commercial |
$1.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.29
|
| Rate for Payer: Nomi Health Commercial |
$1.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.34
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$75.95
|
|
|
Service Code
|
NDC 50268085815
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.96 |
| Max. Negotiated Rate |
$75.95 |
| Rate for Payer: Aetna Commercial |
$68.36
|
| Rate for Payer: ASR ASR |
$73.67
|
| Rate for Payer: BCBS Trust/PPO |
$62.37
|
| Rate for Payer: BCN Commercial |
$62.37
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$71.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$73.67
|
| Rate for Payer: Healthscope Whirlpool |
$75.95
|
| Rate for Payer: Mclaren Commercial |
$68.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.84
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$144.10
|
|
|
Service Code
|
NDC 77333094010
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.32 |
| Max. Negotiated Rate |
$144.10 |
| Rate for Payer: Aetna Commercial |
$129.69
|
| Rate for Payer: Aetna Medicare |
$53.32
|
| Rate for Payer: ASR ASR |
$139.78
|
| Rate for Payer: BCBS Complete |
$57.64
|
| Rate for Payer: BCBS Trust/PPO |
$118.81
|
| Rate for Payer: BCN Commercial |
$118.81
|
| Rate for Payer: Cash Price |
$115.28
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.28
|
| Rate for Payer: Healthscope Commercial |
$139.78
|
| Rate for Payer: Healthscope Whirlpool |
$144.10
|
| Rate for Payer: Mclaren Commercial |
$129.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.48
|
| Rate for Payer: Nomi Health Commercial |
$118.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$126.26
|
| Rate for Payer: Priority Health Narrow Network |
$101.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.81
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 77333094025
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna Commercial |
$1.30
|
| Rate for Payer: ASR ASR |
$1.40
|
| Rate for Payer: BCBS Trust/PPO |
$1.18
|
| Rate for Payer: BCN Commercial |
$1.18
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Cofinity Commercial |
$1.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.15
|
| Rate for Payer: Healthscope Commercial |
$1.40
|
| Rate for Payer: Healthscope Whirlpool |
$1.44
|
| Rate for Payer: Mclaren Commercial |
$1.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.22
|
| Rate for Payer: Nomi Health Commercial |
$1.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.27
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$1.52
|
|
|
Service Code
|
NDC 50268085811
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna Commercial |
$1.37
|
| Rate for Payer: Aetna Medicare |
$0.56
|
| Rate for Payer: ASR ASR |
$1.47
|
| Rate for Payer: BCBS Complete |
$0.61
|
| Rate for Payer: BCBS Trust/PPO |
$1.25
|
| Rate for Payer: BCN Commercial |
$1.25
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cofinity Commercial |
$1.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.22
|
| Rate for Payer: Healthscope Commercial |
$1.47
|
| Rate for Payer: Healthscope Whirlpool |
$1.52
|
| Rate for Payer: Mclaren Commercial |
$1.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.29
|
| Rate for Payer: Nomi Health Commercial |
$1.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.33
|
| Rate for Payer: Priority Health Narrow Network |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.34
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$144.10
|
|
|
Service Code
|
NDC 77333094010
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.08 |
| Max. Negotiated Rate |
$144.10 |
| Rate for Payer: Aetna Commercial |
$129.69
|
| Rate for Payer: ASR ASR |
$139.78
|
| Rate for Payer: BCBS Trust/PPO |
$118.33
|
| Rate for Payer: BCN Commercial |
$118.33
|
| Rate for Payer: Cash Price |
$115.28
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.28
|
| Rate for Payer: Healthscope Commercial |
$139.78
|
| Rate for Payer: Healthscope Whirlpool |
$144.10
|
| Rate for Payer: Mclaren Commercial |
$129.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.48
|
| Rate for Payer: Nomi Health Commercial |
$118.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.81
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
NDC 67877025001
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.39 |
| Max. Negotiated Rate |
$155.10 |
| Rate for Payer: Aetna Commercial |
$139.59
|
| Rate for Payer: Aetna Medicare |
$57.39
|
| Rate for Payer: ASR ASR |
$150.45
|
| Rate for Payer: BCBS Complete |
$62.04
|
| Rate for Payer: BCBS Trust/PPO |
$127.88
|
| Rate for Payer: BCN Commercial |
$127.88
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$145.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$150.45
|
| Rate for Payer: Healthscope Whirlpool |
$155.10
|
| Rate for Payer: Mclaren Commercial |
$139.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Nomi Health Commercial |
$127.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$135.90
|
| Rate for Payer: Priority Health Narrow Network |
$108.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.49
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$204.25
|
|
|
Service Code
|
NDC 904664061
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.57 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Aetna Commercial |
$183.82
|
| Rate for Payer: Aetna Medicare |
$75.57
|
| Rate for Payer: ASR ASR |
$198.12
|
| Rate for Payer: BCBS Complete |
$81.70
|
| Rate for Payer: BCBS Trust/PPO |
$168.40
|
| Rate for Payer: BCN Commercial |
$168.40
|
| Rate for Payer: Cash Price |
$163.40
|
| Rate for Payer: Cofinity Commercial |
$192.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.40
|
| Rate for Payer: Healthscope Commercial |
$198.12
|
| Rate for Payer: Healthscope Whirlpool |
$204.25
|
| Rate for Payer: Mclaren Commercial |
$183.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.61
|
| Rate for Payer: Nomi Health Commercial |
$167.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$178.96
|
| Rate for Payer: Priority Health Narrow Network |
$143.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.74
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$204.25
|
|
|
Service Code
|
NDC 904664061
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.19 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Aetna Commercial |
$183.82
|
| Rate for Payer: ASR ASR |
$198.12
|
| Rate for Payer: BCBS Trust/PPO |
$167.73
|
| Rate for Payer: BCN Commercial |
$167.73
|
| Rate for Payer: Cash Price |
$163.40
|
| Rate for Payer: Cofinity Commercial |
$192.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.40
|
| Rate for Payer: Healthscope Commercial |
$198.12
|
| Rate for Payer: Healthscope Whirlpool |
$204.25
|
| Rate for Payer: Mclaren Commercial |
$183.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.61
|
| Rate for Payer: Nomi Health Commercial |
$167.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.74
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$155.10
|
|
|
Service Code
|
NDC 67877025001
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.33 |
| Max. Negotiated Rate |
$155.10 |
| Rate for Payer: Aetna Commercial |
$139.59
|
| Rate for Payer: ASR ASR |
$150.45
|
| Rate for Payer: BCBS Trust/PPO |
$127.37
|
| Rate for Payer: BCN Commercial |
$127.37
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$145.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$150.45
|
| Rate for Payer: Healthscope Whirlpool |
$155.10
|
| Rate for Payer: Mclaren Commercial |
$139.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Nomi Health Commercial |
$127.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.49
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$404.20
|
|
|
Service Code
|
NDC 904663861
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$303.15 |
| Max. Negotiated Rate |
$404.20 |
| Rate for Payer: Aetna Commercial |
$363.78
|
| Rate for Payer: ASR ASR |
$392.07
|
| Rate for Payer: BCBS Trust/PPO |
$331.93
|
| Rate for Payer: BCN Commercial |
$331.93
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$392.07
|
| Rate for Payer: Healthscope Whirlpool |
$404.20
|
| Rate for Payer: Mclaren Commercial |
$363.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.70
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$401.85
|
|
|
Service Code
|
NDC 67877024238
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$301.39 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna Commercial |
$361.67
|
| Rate for Payer: ASR ASR |
$389.79
|
| Rate for Payer: BCBS Trust/PPO |
$330.00
|
| Rate for Payer: BCN Commercial |
$330.00
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Commercial |
$377.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$389.79
|
| Rate for Payer: Healthscope Whirlpool |
$401.85
|
| Rate for Payer: Mclaren Commercial |
$361.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: Nomi Health Commercial |
$329.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$353.63
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
OP
|
$404.20
|
|
|
Service Code
|
NDC 904663861
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.55 |
| Max. Negotiated Rate |
$404.20 |
| Rate for Payer: Aetna Commercial |
$363.78
|
| Rate for Payer: Aetna Medicare |
$149.55
|
| Rate for Payer: ASR ASR |
$392.07
|
| Rate for Payer: BCBS Complete |
$161.68
|
| Rate for Payer: BCBS Trust/PPO |
$333.26
|
| Rate for Payer: BCN Commercial |
$333.26
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$392.07
|
| Rate for Payer: Healthscope Whirlpool |
$404.20
|
| Rate for Payer: Mclaren Commercial |
$363.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$354.16
|
| Rate for Payer: Priority Health Narrow Network |
$283.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.70
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
OP
|
$401.85
|
|
|
Service Code
|
NDC 67877024238
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.68 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna Commercial |
$361.67
|
| Rate for Payer: Aetna Medicare |
$148.68
|
| Rate for Payer: ASR ASR |
$389.79
|
| Rate for Payer: BCBS Complete |
$160.74
|
| Rate for Payer: BCBS Trust/PPO |
$331.33
|
| Rate for Payer: BCN Commercial |
$331.33
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Commercial |
$377.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$389.79
|
| Rate for Payer: Healthscope Whirlpool |
$401.85
|
| Rate for Payer: Mclaren Commercial |
$361.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: Nomi Health Commercial |
$329.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$352.10
|
| Rate for Payer: Priority Health Narrow Network |
$281.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$353.63
|
|
