|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$6,276.73
|
|
|
Service Code
|
APR-DRG 7503
|
| Min. Negotiated Rate |
$5,674.92 |
| Max. Negotiated Rate |
$6,276.73 |
| Rate for Payer: BCBS Complete |
$6,276.73
|
| Rate for Payer: Mclaren Medicaid |
$5,977.84
|
| Rate for Payer: Meridian Medicaid |
$6,276.73
|
| Rate for Payer: PHP Medicaid |
$5,674.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,977.84
|
| Rate for Payer: UHC Medicaid |
$5,977.84
|
| Rate for Payer: UHCCP Medicaid |
$5,977.84
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$438.04
|
|
|
Service Code
|
NDC 10019055303
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.08 |
| Max. Negotiated Rate |
$438.04 |
| Rate for Payer: Aetna Commercial |
$394.24
|
| Rate for Payer: Aetna Medicare |
$162.08
|
| Rate for Payer: ASR ASR |
$424.90
|
| Rate for Payer: BCBS Complete |
$175.22
|
| Rate for Payer: BCBS Trust/PPO |
$361.17
|
| Rate for Payer: BCN Commercial |
$361.17
|
| 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 |
$424.90
|
| Rate for Payer: Healthscope Whirlpool |
$438.04
|
| Rate for Payer: Mclaren Commercial |
$394.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.34
|
| Rate for Payer: Nomi Health Commercial |
$359.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$383.81
|
| Rate for Payer: Priority Health Narrow Network |
$307.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.48
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$438.04
|
|
|
Service Code
|
NDC 10019055303
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$328.53 |
| 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 |
$359.72
|
| Rate for Payer: BCN Commercial |
$359.72
|
| 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 |
$424.90
|
| Rate for Payer: Healthscope Whirlpool |
$438.04
|
| Rate for Payer: Mclaren Commercial |
$394.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.34
|
| Rate for Payer: Nomi Health Commercial |
$359.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.48
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$43.81
|
|
|
Service Code
|
NDC 10019055390
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.85 |
| 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 |
$35.97
|
| Rate for Payer: BCN Commercial |
$35.97
|
| Rate for Payer: Cash Price |
$35.04
|
| Rate for Payer: Cofinity Commercial |
$41.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.04
|
| Rate for Payer: Healthscope Commercial |
$42.49
|
| Rate for Payer: Healthscope Whirlpool |
$43.80
|
| Rate for Payer: Mclaren Commercial |
$39.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.23
|
| Rate for Payer: Nomi Health Commercial |
$35.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.55
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$43.81
|
|
|
Service Code
|
NDC 10019055390
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.21 |
| Max. Negotiated Rate |
$43.80 |
| Rate for Payer: Aetna Commercial |
$39.42
|
| Rate for Payer: Aetna Medicare |
$16.21
|
| Rate for Payer: ASR ASR |
$42.49
|
| Rate for Payer: BCBS Complete |
$17.52
|
| Rate for Payer: BCBS Trust/PPO |
$36.12
|
| Rate for Payer: BCN Commercial |
$36.12
|
| Rate for Payer: Cash Price |
$35.04
|
| Rate for Payer: Cofinity Commercial |
$41.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.04
|
| Rate for Payer: Healthscope Commercial |
$42.49
|
| Rate for Payer: Healthscope Whirlpool |
$43.80
|
| Rate for Payer: Mclaren Commercial |
$39.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.23
|
| Rate for Payer: Nomi Health Commercial |
$35.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$38.38
|
| Rate for Payer: Priority Health Narrow Network |
$30.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.55
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$98.69
|
|
|
Service Code
|
NDC 50742050504
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.02 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Aetna Commercial |
$88.82
|
| Rate for Payer: ASR ASR |
$95.73
|
| Rate for Payer: BCBS Trust/PPO |
$81.04
|
| Rate for Payer: BCN Commercial |
$81.04
|
| Rate for Payer: Cash Price |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$92.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.95
|
| Rate for Payer: Healthscope Commercial |
$95.73
|
| Rate for Payer: Healthscope Whirlpool |
$98.69
|
| Rate for Payer: Mclaren Commercial |
$88.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.88
|
| Rate for Payer: Nomi Health Commercial |
$80.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.84
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$98.69
|
|
|
Service Code
|
NDC 50742050504
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Aetna Commercial |
$88.82
|
| Rate for Payer: Aetna Medicare |
$36.51
|
| Rate for Payer: ASR ASR |
$95.73
|
| Rate for Payer: BCBS Complete |
$39.47
|
| Rate for Payer: BCBS Trust/PPO |
$81.37
|
| Rate for Payer: BCN Commercial |
$81.37
|
| Rate for Payer: Cash Price |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$92.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.95
|
| Rate for Payer: Healthscope Commercial |
$95.73
|
| Rate for Payer: Healthscope Whirlpool |
$98.69
|
| Rate for Payer: Mclaren Commercial |
$88.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.88
|
| Rate for Payer: Nomi Health Commercial |
$80.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$86.47
|
| Rate for Payer: Priority Health Narrow Network |
$69.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.84
|
|
|
SCREENING OF A PATIENT
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS D0190
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$22.02 |
| 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: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.02
|
| Rate for Payer: UHC Exchange |
$22.02
|
| Rate for Payer: UHC Medicaid |
$19.20
|
| Rate for Payer: UHCCP Medicaid |
$19.20
|
|
|
SEIZURE
|
Facility
|
IP
|
$4,386.85
|
|
|
Service Code
|
APR-DRG 0532
|
| Min. Negotiated Rate |
$3,966.24 |
| Max. Negotiated Rate |
$4,386.85 |
| Rate for Payer: BCBS Complete |
$4,386.85
|
| Rate for Payer: Mclaren Medicaid |
$4,177.95
|
| Rate for Payer: Meridian Medicaid |
$4,386.85
|
| Rate for Payer: PHP Medicaid |
$3,966.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,177.95
|
| Rate for Payer: UHC Medicaid |
$4,177.95
|
| Rate for Payer: UHCCP Medicaid |
$4,177.95
|
|
|
SEIZURE
|
Facility
|
IP
|
$3,431.01
|
|
|
Service Code
|
APR-DRG 0531
|
| Min. Negotiated Rate |
$3,102.04 |
| Max. Negotiated Rate |
$3,431.01 |
| Rate for Payer: BCBS Complete |
$3,431.01
|
| Rate for Payer: Mclaren Medicaid |
$3,267.62
|
| Rate for Payer: Meridian Medicaid |
$3,431.01
|
| Rate for Payer: PHP Medicaid |
$3,102.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,267.62
|
| Rate for Payer: UHC Medicaid |
$3,267.62
|
| Rate for Payer: UHCCP Medicaid |
$3,267.62
|
|
|
SEIZURE
|
Facility
|
IP
|
$13,409.58
|
|
|
Service Code
|
APR-DRG 0534
|
| Min. Negotiated Rate |
$12,123.87 |
| Max. Negotiated Rate |
$13,409.58 |
| Rate for Payer: BCBS Complete |
$13,409.58
|
| Rate for Payer: Mclaren Medicaid |
$12,771.03
|
| Rate for Payer: Meridian Medicaid |
$13,409.58
|
| Rate for Payer: PHP Medicaid |
$12,123.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,771.03
|
| Rate for Payer: UHC Medicaid |
$12,771.03
|
| Rate for Payer: UHCCP Medicaid |
$12,771.03
|
|
|
SEIZURE
|
Facility
|
IP
|
$6,525.23
|
|
|
Service Code
|
APR-DRG 0533
|
| Min. Negotiated Rate |
$5,899.59 |
| Max. Negotiated Rate |
$6,525.23 |
| Rate for Payer: BCBS Complete |
$6,525.23
|
| Rate for Payer: Mclaren Medicaid |
$6,214.51
|
| Rate for Payer: Meridian Medicaid |
$6,525.23
|
| Rate for Payer: PHP Medicaid |
$5,899.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,214.51
|
| Rate for Payer: UHC Medicaid |
$6,214.51
|
| Rate for Payer: UHCCP Medicaid |
$6,214.51
|
|
|
SEIZURES WITH MCC
|
Facility
|
IP
|
$26,609.31
|
|
|
Service Code
|
MSDRG 100
|
| Min. Negotiated Rate |
$14,916.73 |
| Max. Negotiated Rate |
$26,609.31 |
| Rate for Payer: Aetna Medicare |
$15,701.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,627.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,627.28
|
| Rate for Payer: BCBS MAPPO |
$15,701.82
|
| Rate for Payer: BCN Medicare Advantage |
$15,701.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,701.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,701.82
|
| Rate for Payer: Mclaren Medicare |
$15,701.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,486.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,057.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,272.00
|
| Rate for Payer: PACE Medicare |
$14,916.73
|
| Rate for Payer: PACE SWMI |
$15,701.82
|
| Rate for Payer: PHP Commercial |
$17,272.00
|
| Rate for Payer: PHP Medicare Advantage |
$15,701.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$26,609.31
|
| Rate for Payer: Priority Health Medicare |
$15,701.82
|
| Rate for Payer: Priority Health Narrow Network |
$21,287.45
|
| Rate for Payer: Railroad Medicare Medicare |
$15,701.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,701.82
|
| Rate for Payer: UHC Exchange |
$24,337.82
|
| Rate for Payer: UHCCP DNSP |
$15,701.82
|
| Rate for Payer: VA VA |
$15,701.82
|
|
|
SEIZURES WITHOUT MCC
|
Facility
|
IP
|
$12,794.18
|
|
|
Service Code
|
MSDRG 101
|
| Min. Negotiated Rate |
$7,841.59 |
| Max. Negotiated Rate |
$12,794.18 |
| Rate for Payer: Aetna Medicare |
$8,254.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,317.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,317.89
|
| Rate for Payer: BCBS MAPPO |
$8,254.31
|
| Rate for Payer: BCN Medicare Advantage |
$8,254.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,254.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,254.31
|
| Rate for Payer: Mclaren Medicare |
$8,254.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,667.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,492.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,079.74
|
| Rate for Payer: PACE Medicare |
$7,841.59
|
| Rate for Payer: PACE SWMI |
$8,254.31
|
| Rate for Payer: PHP Commercial |
$9,079.74
|
| Rate for Payer: PHP Medicare Advantage |
$8,254.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12,400.64
|
| Rate for Payer: Priority Health Medicare |
$8,254.31
|
| Rate for Payer: Priority Health Narrow Network |
$9,920.51
|
| Rate for Payer: Railroad Medicare Medicare |
$8,254.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,254.31
|
| Rate for Payer: UHC Exchange |
$12,794.18
|
| Rate for Payer: UHCCP DNSP |
$8,254.31
|
| Rate for Payer: VA VA |
$8,254.31
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
NDC 904652261
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.84 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Medicare |
$48.84
|
| Rate for Payer: ASR ASR |
$128.04
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS Trust/PPO |
$108.83
|
| Rate for Payer: BCN Commercial |
$108.83
|
| 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 |
$128.04
|
| Rate for Payer: Healthscope Whirlpool |
$132.00
|
| Rate for Payer: Mclaren Commercial |
$118.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.20
|
| Rate for Payer: Nomi Health Commercial |
$108.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$115.66
|
| Rate for Payer: Priority Health Narrow Network |
$92.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.16
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$163.80
|
|
|
Service Code
|
NDC 51645085101
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.85 |
| 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 |
$134.51
|
| Rate for Payer: BCN Commercial |
$134.51
|
| 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 |
$158.89
|
| Rate for Payer: Healthscope Whirlpool |
$163.80
|
| Rate for Payer: Mclaren Commercial |
$147.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.23
|
| Rate for Payer: Nomi Health Commercial |
$134.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.14
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
NDC 904725261
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: ASR ASR |
$143.56
|
| Rate for Payer: BCBS Trust/PPO |
$121.54
|
| Rate for Payer: BCN Commercial |
$121.54
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$139.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$143.56
|
| Rate for Payer: Healthscope Whirlpool |
$148.00
|
| Rate for Payer: Mclaren Commercial |
$133.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Nomi Health Commercial |
$121.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.24
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$132.30
|
|
|
Service Code
|
NDC 49483008001
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.22 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna Commercial |
$119.07
|
| Rate for Payer: ASR ASR |
$128.33
|
| Rate for Payer: BCBS Trust/PPO |
$108.64
|
| Rate for Payer: BCN Commercial |
$108.64
|
| Rate for Payer: Cash Price |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$124.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.84
|
| Rate for Payer: Healthscope Commercial |
$128.33
|
| Rate for Payer: Healthscope Whirlpool |
$132.30
|
| Rate for Payer: Mclaren Commercial |
$119.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.45
|
| Rate for Payer: Nomi Health Commercial |
$108.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.42
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
NDC 904652261
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.00 |
| 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 |
$108.40
|
| Rate for Payer: BCN Commercial |
$108.40
|
| 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 |
$128.04
|
| Rate for Payer: Healthscope Whirlpool |
$132.00
|
| Rate for Payer: Mclaren Commercial |
$118.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.20
|
| Rate for Payer: Nomi Health Commercial |
$108.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.16
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$132.30
|
|
|
Service Code
|
NDC 49483008001
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.95 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna Commercial |
$119.07
|
| Rate for Payer: Aetna Medicare |
$48.95
|
| Rate for Payer: ASR ASR |
$128.33
|
| Rate for Payer: BCBS Complete |
$52.92
|
| Rate for Payer: BCBS Trust/PPO |
$109.08
|
| Rate for Payer: BCN Commercial |
$109.08
|
| Rate for Payer: Cash Price |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$124.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.84
|
| Rate for Payer: Healthscope Commercial |
$128.33
|
| Rate for Payer: Healthscope Whirlpool |
$132.30
|
| Rate for Payer: Mclaren Commercial |
$119.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.45
|
| Rate for Payer: Nomi Health Commercial |
$108.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$115.92
|
| Rate for Payer: Priority Health Narrow Network |
$92.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.42
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
NDC 904725261
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.76 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Aetna Medicare |
$54.76
|
| Rate for Payer: ASR ASR |
$143.56
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: BCBS Trust/PPO |
$122.03
|
| Rate for Payer: BCN Commercial |
$122.03
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$139.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$143.56
|
| Rate for Payer: Healthscope Whirlpool |
$148.00
|
| Rate for Payer: Mclaren Commercial |
$133.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Nomi Health Commercial |
$121.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$129.68
|
| Rate for Payer: Priority Health Narrow Network |
$103.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.24
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$163.80
|
|
|
Service Code
|
NDC 51645085101
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna Commercial |
$147.42
|
| Rate for Payer: Aetna Medicare |
$60.61
|
| Rate for Payer: ASR ASR |
$158.89
|
| Rate for Payer: BCBS Complete |
$65.52
|
| Rate for Payer: BCBS Trust/PPO |
$135.05
|
| Rate for Payer: BCN Commercial |
$135.05
|
| 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 |
$158.89
|
| Rate for Payer: Healthscope Whirlpool |
$163.80
|
| Rate for Payer: Mclaren Commercial |
$147.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.23
|
| Rate for Payer: Nomi Health Commercial |
$134.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$143.52
|
| Rate for Payer: Priority Health Narrow Network |
$114.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.14
|
|
|
SEPTIC ARTHRITIS WITH CC
|
Facility
|
IP
|
$16,585.48
|
|
|
Service Code
|
MSDRG 549
|
| Min. Negotiated Rate |
$9,925.41 |
| Max. Negotiated Rate |
$16,585.48 |
| Rate for Payer: Aetna Medicare |
$10,447.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,059.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,059.75
|
| Rate for Payer: BCBS MAPPO |
$10,447.80
|
| Rate for Payer: BCN Medicare Advantage |
$10,447.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,447.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,447.80
|
| Rate for Payer: Mclaren Medicare |
$10,447.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,970.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,014.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,492.58
|
| Rate for Payer: PACE Medicare |
$9,925.41
|
| Rate for Payer: PACE SWMI |
$10,447.80
|
| Rate for Payer: PHP Commercial |
$11,492.58
|
| Rate for Payer: PHP Medicare Advantage |
$10,447.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16,585.48
|
| Rate for Payer: Priority Health Medicare |
$10,447.80
|
| Rate for Payer: Priority Health Narrow Network |
$13,268.38
|
| Rate for Payer: Railroad Medicare Medicare |
$10,447.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,447.80
|
| Rate for Payer: UHC Exchange |
$16,194.09
|
| Rate for Payer: UHCCP DNSP |
$10,447.80
|
| Rate for Payer: VA VA |
$10,447.80
|
|
|
SEPTIC ARTHRITIS WITH MCC
|
Facility
|
IP
|
$26,528.25
|
|
|
Service Code
|
MSDRG 548
|
| Min. Negotiated Rate |
$14,876.37 |
| Max. Negotiated Rate |
$26,528.25 |
| Rate for Payer: Aetna Medicare |
$15,659.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,574.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,574.17
|
| Rate for Payer: BCBS MAPPO |
$15,659.34
|
| Rate for Payer: BCN Medicare Advantage |
$15,659.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,659.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,659.34
|
| Rate for Payer: Mclaren Medicare |
$15,659.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,442.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,008.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,225.27
|
| Rate for Payer: PACE Medicare |
$14,876.37
|
| Rate for Payer: PACE SWMI |
$15,659.34
|
| Rate for Payer: PHP Commercial |
$17,225.27
|
| Rate for Payer: PHP Medicare Advantage |
$15,659.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$26,528.25
|
| Rate for Payer: Priority Health Medicare |
$15,659.34
|
| Rate for Payer: Priority Health Narrow Network |
$21,222.60
|
| Rate for Payer: Railroad Medicare Medicare |
$15,659.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,659.34
|
| Rate for Payer: UHC Exchange |
$24,271.98
|
| Rate for Payer: UHCCP DNSP |
$15,659.34
|
| Rate for Payer: VA VA |
$15,659.34
|
|
|
SEPTIC ARTHRITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,476.04
|
|
|
Service Code
|
MSDRG 550
|
| Min. Negotiated Rate |
$7,646.61 |
| Max. Negotiated Rate |
$12,476.04 |
| Rate for Payer: Aetna Medicare |
$8,049.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,061.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,061.33
|
| Rate for Payer: BCBS MAPPO |
$8,049.06
|
| Rate for Payer: BCN Medicare Advantage |
$8,049.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,049.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,049.06
|
| Rate for Payer: Mclaren Medicare |
$8,049.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,451.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,256.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,853.97
|
| Rate for Payer: PACE Medicare |
$7,646.61
|
| Rate for Payer: PACE SWMI |
$8,049.06
|
| Rate for Payer: PHP Commercial |
$8,853.97
|
| Rate for Payer: PHP Medicare Advantage |
$8,049.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12,009.09
|
| Rate for Payer: Priority Health Medicare |
$8,049.06
|
| Rate for Payer: Priority Health Narrow Network |
$9,607.27
|
| Rate for Payer: Railroad Medicare Medicare |
$8,049.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,049.06
|
| Rate for Payer: UHC Exchange |
$12,476.04
|
| Rate for Payer: UHCCP DNSP |
$8,049.06
|
| Rate for Payer: VA VA |
$8,049.06
|
|
