|
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION
|
Facility
|
OP
|
$20.69
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
153276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$20.69 |
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Commercial |
$22.35
|
| Rate for Payer: Aetna Commercial |
$26.11
|
| Rate for Payer: Aetna Medicare |
$9.19
|
| Rate for Payer: Aetna Medicare |
$7.66
|
| Rate for Payer: Aetna Medicare |
$10.74
|
| Rate for Payer: ASR ASR |
$28.14
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: ASR ASR |
$24.09
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Complete |
$11.61
|
| Rate for Payer: BCBS Complete |
$9.93
|
| Rate for Payer: BCBS Trust/PPO |
$17.06
|
| Rate for Payer: BCBS Trust/PPO |
$20.47
|
| Rate for Payer: BCBS Trust/PPO |
$23.92
|
| Rate for Payer: BCN Commercial |
$17.06
|
| Rate for Payer: BCN Commercial |
$20.47
|
| Rate for Payer: BCN Commercial |
$23.92
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: Cash Price |
$23.21
|
| Rate for Payer: Cash Price |
$23.21
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$23.34
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$27.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.86
|
| Rate for Payer: Healthscope Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Healthscope Commercial |
$24.09
|
| Rate for Payer: Healthscope Whirlpool |
$24.83
|
| Rate for Payer: Healthscope Whirlpool |
$20.69
|
| Rate for Payer: Healthscope Whirlpool |
$29.01
|
| Rate for Payer: Mclaren Commercial |
$26.11
|
| Rate for Payer: Mclaren Commercial |
$22.35
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Nomi Health Commercial |
$23.79
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$20.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.05
|
| Rate for Payer: Priority Health Narrow Network |
$0.04
|
| Rate for Payer: Priority Health Narrow Network |
$0.04
|
| Rate for Payer: Priority Health Narrow Network |
$0.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
|
|
ROSUVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$2.61
|
|
|
Service Code
|
NDC 50268070911
|
| Hospital Charge Code |
35134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Aetna Commercial |
$2.35
|
| Rate for Payer: ASR ASR |
$2.53
|
| Rate for Payer: BCBS Trust/PPO |
$2.14
|
| Rate for Payer: BCN Commercial |
$2.14
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.09
|
| Rate for Payer: Healthscope Commercial |
$2.53
|
| Rate for Payer: Healthscope Whirlpool |
$2.61
|
| Rate for Payer: Mclaren Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.22
|
| Rate for Payer: Nomi Health Commercial |
$2.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.29
|
|
|
ROSUVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$638.88
|
|
|
Service Code
|
NDC 60687024501
|
| Hospital Charge Code |
35134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$479.16 |
| Max. Negotiated Rate |
$638.88 |
| Rate for Payer: Aetna Commercial |
$574.99
|
| Rate for Payer: ASR ASR |
$619.71
|
| Rate for Payer: BCBS Trust/PPO |
$524.65
|
| Rate for Payer: BCN Commercial |
$524.65
|
| Rate for Payer: Cash Price |
$511.10
|
| Rate for Payer: Cofinity Commercial |
$600.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$511.10
|
| Rate for Payer: Healthscope Commercial |
$619.71
|
| Rate for Payer: Healthscope Whirlpool |
$638.88
|
| Rate for Payer: Mclaren Commercial |
$574.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$543.05
|
| Rate for Payer: Nomi Health Commercial |
$523.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$479.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$562.21
|
|
|
ROSUVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$2.61
|
|
|
Service Code
|
NDC 50268070911
|
| Hospital Charge Code |
35134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Aetna Commercial |
$2.35
|
| Rate for Payer: Aetna Medicare |
$0.96
|
| Rate for Payer: ASR ASR |
$2.53
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: BCBS Trust/PPO |
$2.15
|
| Rate for Payer: BCN Commercial |
$2.15
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.09
|
| Rate for Payer: Healthscope Commercial |
$2.53
|
| Rate for Payer: Healthscope Whirlpool |
$2.61
|
| Rate for Payer: Mclaren Commercial |
$2.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.22
|
| Rate for Payer: Nomi Health Commercial |
$2.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.28
|
| Rate for Payer: Priority Health Narrow Network |
$1.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.29
|
|
|
ROSUVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$130.32
|
|
|
Service Code
|
NDC 50268070915
|
| Hospital Charge Code |
35134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.74 |
| Max. Negotiated Rate |
$130.32 |
| Rate for Payer: Aetna Commercial |
$117.29
|
| Rate for Payer: ASR ASR |
$126.41
|
| Rate for Payer: BCBS Trust/PPO |
$107.02
|
| Rate for Payer: BCN Commercial |
$107.02
|
| Rate for Payer: Cash Price |
$104.26
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.26
|
| Rate for Payer: Healthscope Commercial |
$126.41
|
| Rate for Payer: Healthscope Whirlpool |
$130.32
|
| Rate for Payer: Mclaren Commercial |
$117.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.77
|
| Rate for Payer: Nomi Health Commercial |
$106.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.68
|
|
|
ROSUVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$71.91
|
|
|
Service Code
|
NDC 68462026290
|
| Hospital Charge Code |
35134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$71.91 |
| Rate for Payer: Aetna Commercial |
$64.72
|
| Rate for Payer: Aetna Medicare |
$26.61
|
| Rate for Payer: ASR ASR |
$69.75
|
| Rate for Payer: BCBS Complete |
$28.76
|
| Rate for Payer: BCBS Trust/PPO |
$59.29
|
| Rate for Payer: BCN Commercial |
$59.29
|
| Rate for Payer: Cash Price |
$57.53
|
| Rate for Payer: Cofinity Commercial |
$67.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.53
|
| Rate for Payer: Healthscope Commercial |
$69.75
|
| Rate for Payer: Healthscope Whirlpool |
$71.91
|
| Rate for Payer: Mclaren Commercial |
$64.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.12
|
| Rate for Payer: Nomi Health Commercial |
$58.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$63.01
|
| Rate for Payer: Priority Health Narrow Network |
$50.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.28
|
|
|
ROSUVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$71.91
|
|
|
Service Code
|
NDC 68462026290
|
| Hospital Charge Code |
35134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.93 |
| Max. Negotiated Rate |
$71.91 |
| Rate for Payer: Aetna Commercial |
$64.72
|
| Rate for Payer: ASR ASR |
$69.75
|
| Rate for Payer: BCBS Trust/PPO |
$59.05
|
| Rate for Payer: BCN Commercial |
$59.05
|
| Rate for Payer: Cash Price |
$57.53
|
| Rate for Payer: Cofinity Commercial |
$67.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.53
|
| Rate for Payer: Healthscope Commercial |
$69.75
|
| Rate for Payer: Healthscope Whirlpool |
$71.91
|
| Rate for Payer: Mclaren Commercial |
$64.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.12
|
| Rate for Payer: Nomi Health Commercial |
$58.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.28
|
|
|
ROSUVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$638.88
|
|
|
Service Code
|
NDC 60687024501
|
| Hospital Charge Code |
35134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.39 |
| Max. Negotiated Rate |
$638.88 |
| Rate for Payer: Aetna Commercial |
$574.99
|
| Rate for Payer: Aetna Medicare |
$236.39
|
| Rate for Payer: ASR ASR |
$619.71
|
| Rate for Payer: BCBS Complete |
$255.55
|
| Rate for Payer: BCBS Trust/PPO |
$526.76
|
| Rate for Payer: BCN Commercial |
$526.76
|
| Rate for Payer: Cash Price |
$511.10
|
| Rate for Payer: Cofinity Commercial |
$600.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$511.10
|
| Rate for Payer: Healthscope Commercial |
$619.71
|
| Rate for Payer: Healthscope Whirlpool |
$638.88
|
| Rate for Payer: Mclaren Commercial |
$574.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$511.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$543.05
|
| Rate for Payer: Nomi Health Commercial |
$523.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$479.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$559.79
|
| Rate for Payer: Priority Health Narrow Network |
$447.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$562.21
|
|
|
ROSUVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$130.32
|
|
|
Service Code
|
NDC 50268070915
|
| Hospital Charge Code |
35134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.22 |
| Max. Negotiated Rate |
$130.32 |
| Rate for Payer: Aetna Commercial |
$117.29
|
| Rate for Payer: Aetna Medicare |
$48.22
|
| Rate for Payer: ASR ASR |
$126.41
|
| Rate for Payer: BCBS Complete |
$52.13
|
| Rate for Payer: BCBS Trust/PPO |
$107.45
|
| Rate for Payer: BCN Commercial |
$107.45
|
| Rate for Payer: Cash Price |
$104.26
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.26
|
| Rate for Payer: Healthscope Commercial |
$126.41
|
| Rate for Payer: Healthscope Whirlpool |
$130.32
|
| Rate for Payer: Mclaren Commercial |
$117.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.77
|
| Rate for Payer: Nomi Health Commercial |
$106.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$114.19
|
| Rate for Payer: Priority Health Narrow Network |
$91.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.68
|
|
|
ROSUVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$6.39
|
|
|
Service Code
|
NDC 60687024511
|
| Hospital Charge Code |
35134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$6.39 |
| Rate for Payer: Aetna Commercial |
$5.75
|
| Rate for Payer: Aetna Medicare |
$2.36
|
| Rate for Payer: ASR ASR |
$6.20
|
| Rate for Payer: BCBS Complete |
$2.56
|
| Rate for Payer: BCBS Trust/PPO |
$5.27
|
| Rate for Payer: BCN Commercial |
$5.27
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cofinity Commercial |
$6.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.11
|
| Rate for Payer: Healthscope Commercial |
$6.20
|
| Rate for Payer: Healthscope Whirlpool |
$6.39
|
| Rate for Payer: Mclaren Commercial |
$5.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.43
|
| Rate for Payer: Nomi Health Commercial |
$5.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.60
|
| Rate for Payer: Priority Health Narrow Network |
$4.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.62
|
|
|
ROSUVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$6.39
|
|
|
Service Code
|
NDC 60687024511
|
| Hospital Charge Code |
35134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$6.39 |
| Rate for Payer: Aetna Commercial |
$5.75
|
| Rate for Payer: ASR ASR |
$6.20
|
| Rate for Payer: BCBS Trust/PPO |
$5.25
|
| Rate for Payer: BCN Commercial |
$5.25
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cofinity Commercial |
$6.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.11
|
| Rate for Payer: Healthscope Commercial |
$6.20
|
| Rate for Payer: Healthscope Whirlpool |
$6.39
|
| Rate for Payer: Mclaren Commercial |
$5.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.43
|
| Rate for Payer: Nomi Health Commercial |
$5.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.62
|
|
|
SACCHAROMYCES BOULARDII 250 MG CAPSULE
|
Facility
|
OP
|
$156.96
|
|
|
Service Code
|
NDC 904723006
|
| Hospital Charge Code |
37343
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.08 |
| Max. Negotiated Rate |
$156.96 |
| Rate for Payer: Aetna Commercial |
$141.26
|
| Rate for Payer: Aetna Medicare |
$58.08
|
| Rate for Payer: ASR ASR |
$152.25
|
| Rate for Payer: BCBS Complete |
$62.78
|
| Rate for Payer: BCBS Trust/PPO |
$129.41
|
| Rate for Payer: BCN Commercial |
$129.41
|
| Rate for Payer: Cash Price |
$125.57
|
| Rate for Payer: Cofinity Commercial |
$147.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.57
|
| Rate for Payer: Healthscope Commercial |
$152.25
|
| Rate for Payer: Healthscope Whirlpool |
$156.96
|
| Rate for Payer: Mclaren Commercial |
$141.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.42
|
| Rate for Payer: Nomi Health Commercial |
$128.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$137.53
|
| Rate for Payer: Priority Health Narrow Network |
$110.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.12
|
|
|
SACCHAROMYCES BOULARDII 250 MG CAPSULE
|
Facility
|
IP
|
$156.96
|
|
|
Service Code
|
NDC 904723006
|
| Hospital Charge Code |
37343
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.72 |
| Max. Negotiated Rate |
$156.96 |
| Rate for Payer: Aetna Commercial |
$141.26
|
| Rate for Payer: ASR ASR |
$152.25
|
| Rate for Payer: BCBS Trust/PPO |
$128.90
|
| Rate for Payer: BCN Commercial |
$128.90
|
| Rate for Payer: Cash Price |
$125.57
|
| Rate for Payer: Cofinity Commercial |
$147.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.57
|
| Rate for Payer: Healthscope Commercial |
$152.25
|
| Rate for Payer: Healthscope Whirlpool |
$156.96
|
| Rate for Payer: Mclaren Commercial |
$141.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.42
|
| Rate for Payer: Nomi Health Commercial |
$128.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.12
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
OP
|
$424.22
|
|
|
Service Code
|
NDC 72205028060
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.96 |
| Max. Negotiated Rate |
$424.22 |
| Rate for Payer: Aetna Commercial |
$381.80
|
| Rate for Payer: Aetna Medicare |
$156.96
|
| Rate for Payer: ASR ASR |
$411.50
|
| Rate for Payer: BCBS Complete |
$169.69
|
| Rate for Payer: BCBS Trust/PPO |
$349.77
|
| Rate for Payer: BCN Commercial |
$349.77
|
| Rate for Payer: Cash Price |
$339.38
|
| Rate for Payer: Cofinity Commercial |
$398.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.38
|
| Rate for Payer: Healthscope Commercial |
$411.50
|
| Rate for Payer: Healthscope Whirlpool |
$424.22
|
| Rate for Payer: Mclaren Commercial |
$381.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$339.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.59
|
| Rate for Payer: Nomi Health Commercial |
$347.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$371.71
|
| Rate for Payer: Priority Health Narrow Network |
$297.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.32
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
IP
|
$2,499.50
|
|
|
Service Code
|
NDC 78065920
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,874.62 |
| Max. Negotiated Rate |
$2,499.50 |
| Rate for Payer: Aetna Commercial |
$2,249.55
|
| Rate for Payer: ASR ASR |
$2,424.51
|
| Rate for Payer: BCBS Trust/PPO |
$2,052.59
|
| Rate for Payer: BCN Commercial |
$2,052.59
|
| Rate for Payer: Cash Price |
$1,999.60
|
| Rate for Payer: Cofinity Commercial |
$2,349.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,999.60
|
| Rate for Payer: Healthscope Commercial |
$2,424.51
|
| Rate for Payer: Healthscope Whirlpool |
$2,499.50
|
| Rate for Payer: Mclaren Commercial |
$2,249.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,124.57
|
| Rate for Payer: Nomi Health Commercial |
$2,049.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,874.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,199.56
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
OP
|
$2,499.50
|
|
|
Service Code
|
NDC 78065920
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$924.81 |
| Max. Negotiated Rate |
$2,499.50 |
| Rate for Payer: Aetna Commercial |
$2,249.55
|
| Rate for Payer: Aetna Medicare |
$924.81
|
| Rate for Payer: ASR ASR |
$2,424.51
|
| Rate for Payer: BCBS Complete |
$999.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,060.84
|
| Rate for Payer: BCN Commercial |
$2,060.84
|
| Rate for Payer: Cash Price |
$1,999.60
|
| Rate for Payer: Cofinity Commercial |
$2,349.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,999.60
|
| Rate for Payer: Healthscope Commercial |
$2,424.51
|
| Rate for Payer: Healthscope Whirlpool |
$2,499.50
|
| Rate for Payer: Mclaren Commercial |
$2,249.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,999.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,124.57
|
| Rate for Payer: Nomi Health Commercial |
$2,049.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,874.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,190.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,752.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,199.56
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
IP
|
$424.22
|
|
|
Service Code
|
NDC 72205028060
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$318.17 |
| Max. Negotiated Rate |
$424.22 |
| Rate for Payer: Aetna Commercial |
$381.80
|
| Rate for Payer: ASR ASR |
$411.50
|
| Rate for Payer: BCBS Trust/PPO |
$348.37
|
| Rate for Payer: BCN Commercial |
$348.37
|
| Rate for Payer: Cash Price |
$339.38
|
| Rate for Payer: Cofinity Commercial |
$398.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.38
|
| Rate for Payer: Healthscope Commercial |
$411.50
|
| Rate for Payer: Healthscope Whirlpool |
$424.22
|
| Rate for Payer: Mclaren Commercial |
$381.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.59
|
| Rate for Payer: Nomi Health Commercial |
$347.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.32
|
|
|
SALIVARY GLAND PROCEDURES
|
Facility
|
IP
|
$16,977.04
|
|
|
Service Code
|
MSDRG 139
|
| Min. Negotiated Rate |
$10,120.39 |
| Max. Negotiated Rate |
$16,977.04 |
| Rate for Payer: Aetna Medicare |
$10,653.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,316.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,316.30
|
| Rate for Payer: BCBS MAPPO |
$10,653.04
|
| Rate for Payer: BCN Medicare Advantage |
$10,653.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,653.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,653.04
|
| Rate for Payer: Mclaren Medicare |
$10,653.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,185.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,251.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,718.34
|
| Rate for Payer: PACE Medicare |
$10,120.39
|
| Rate for Payer: PACE SWMI |
$10,653.04
|
| Rate for Payer: PHP Commercial |
$11,718.34
|
| Rate for Payer: PHP Medicare Advantage |
$10,653.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16,977.04
|
| Rate for Payer: Priority Health Medicare |
$10,653.04
|
| Rate for Payer: Priority Health Narrow Network |
$13,581.63
|
| Rate for Payer: Railroad Medicare Medicare |
$10,653.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,653.04
|
| Rate for Payer: UHC Exchange |
$16,512.21
|
| Rate for Payer: UHCCP DNSP |
$10,653.04
|
| Rate for Payer: VA VA |
$10,653.04
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$3,561.25
|
|
|
Service Code
|
APR-DRG 7611
|
| Min. Negotiated Rate |
$3,219.79 |
| Max. Negotiated Rate |
$3,561.25 |
| Rate for Payer: BCBS Complete |
$3,561.25
|
| Rate for Payer: Mclaren Medicaid |
$3,391.66
|
| Rate for Payer: Meridian Medicaid |
$3,561.25
|
| Rate for Payer: PHP Medicaid |
$3,219.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,391.66
|
| Rate for Payer: UHC Medicaid |
$3,391.66
|
| Rate for Payer: UHCCP Medicaid |
$3,391.66
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$12,079.91
|
|
|
Service Code
|
APR-DRG 7614
|
| Min. Negotiated Rate |
$10,921.68 |
| Max. Negotiated Rate |
$12,079.91 |
| Rate for Payer: BCBS Complete |
$12,079.91
|
| Rate for Payer: Mclaren Medicaid |
$11,504.67
|
| Rate for Payer: Meridian Medicaid |
$12,079.91
|
| Rate for Payer: PHP Medicaid |
$10,921.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,504.67
|
| Rate for Payer: UHC Medicaid |
$11,504.67
|
| Rate for Payer: UHCCP Medicaid |
$11,504.67
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$3,872.96
|
|
|
Service Code
|
APR-DRG 7612
|
| Min. Negotiated Rate |
$3,501.62 |
| Max. Negotiated Rate |
$3,872.96 |
| Rate for Payer: BCBS Complete |
$3,872.96
|
| Rate for Payer: Mclaren Medicaid |
$3,688.53
|
| Rate for Payer: Meridian Medicaid |
$3,872.96
|
| Rate for Payer: PHP Medicaid |
$3,501.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,688.53
|
| Rate for Payer: UHC Medicaid |
$3,688.53
|
| Rate for Payer: UHCCP Medicaid |
$3,688.53
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$7,042.93
|
|
|
Service Code
|
APR-DRG 7613
|
| Min. Negotiated Rate |
$6,367.65 |
| Max. Negotiated Rate |
$7,042.93 |
| Rate for Payer: BCBS Complete |
$7,042.93
|
| Rate for Payer: Mclaren Medicaid |
$6,707.56
|
| Rate for Payer: Meridian Medicaid |
$7,042.93
|
| Rate for Payer: PHP Medicaid |
$6,367.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,707.56
|
| Rate for Payer: UHC Medicaid |
$6,707.56
|
| Rate for Payer: UHCCP Medicaid |
$6,707.56
|
|
|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$12,516.96
|
|
|
Service Code
|
APR-DRG 7504
|
| Min. Negotiated Rate |
$11,316.83 |
| Max. Negotiated Rate |
$12,516.96 |
| Rate for Payer: BCBS Complete |
$12,516.96
|
| Rate for Payer: Mclaren Medicaid |
$11,920.91
|
| Rate for Payer: Meridian Medicaid |
$12,516.96
|
| Rate for Payer: PHP Medicaid |
$11,316.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,920.91
|
| Rate for Payer: UHC Medicaid |
$11,920.91
|
| Rate for Payer: UHCCP Medicaid |
$11,920.91
|
|
|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$4,961.22
|
|
|
Service Code
|
APR-DRG 7502
|
| Min. Negotiated Rate |
$4,485.54 |
| Max. Negotiated Rate |
$4,961.22 |
| Rate for Payer: BCBS Complete |
$4,961.22
|
| Rate for Payer: Mclaren Medicaid |
$4,724.98
|
| Rate for Payer: Meridian Medicaid |
$4,961.22
|
| Rate for Payer: PHP Medicaid |
$4,485.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,724.98
|
| Rate for Payer: UHC Medicaid |
$4,724.98
|
| Rate for Payer: UHCCP Medicaid |
$4,724.98
|
|
|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$3,910.56
|
|
|
Service Code
|
APR-DRG 7501
|
| Min. Negotiated Rate |
$3,535.62 |
| Max. Negotiated Rate |
$3,910.56 |
| Rate for Payer: BCBS Complete |
$3,910.56
|
| Rate for Payer: Mclaren Medicaid |
$3,724.34
|
| Rate for Payer: Meridian Medicaid |
$3,910.56
|
| Rate for Payer: PHP Medicaid |
$3,535.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,724.34
|
| Rate for Payer: UHC Medicaid |
$3,724.34
|
| Rate for Payer: UHCCP Medicaid |
$3,724.34
|
|
