|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$851.01
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$536.14 |
| Max. Negotiated Rate |
$765.91 |
| Rate for Payer: Aetna Commercial |
$723.36
|
| Rate for Payer: Aetna Commercial |
$30.72
|
| Rate for Payer: Aetna Commercial |
$112.76
|
| Rate for Payer: Aetna Commercial |
$31.09
|
| Rate for Payer: Aetna Commercial |
$45.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.16
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cash Price |
$680.81
|
| Rate for Payer: Cash Price |
$28.91
|
| Rate for Payer: Cash Price |
$106.13
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Cofinity Advantage |
$37.67
|
| Rate for Payer: Cofinity Advantage |
$25.61
|
| Rate for Payer: Cofinity Advantage |
$595.71
|
| Rate for Payer: Cofinity Advantage |
$92.86
|
| Rate for Payer: Cofinity Advantage |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$731.87
|
| Rate for Payer: Cofinity Commercial |
$31.46
|
| Rate for Payer: Cofinity Commercial |
$46.28
|
| Rate for Payer: Cofinity Commercial |
$31.08
|
| Rate for Payer: Cofinity Commercial |
$114.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.81
|
| Rate for Payer: Healthscope Commercial |
$32.92
|
| Rate for Payer: Healthscope Commercial |
$765.91
|
| Rate for Payer: Healthscope Commercial |
$32.53
|
| Rate for Payer: Healthscope Commercial |
$119.39
|
| Rate for Payer: Healthscope Commercial |
$48.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$638.26
|
| Rate for Payer: PHP Commercial |
$112.76
|
| Rate for Payer: PHP Commercial |
$45.74
|
| Rate for Payer: PHP Commercial |
$723.36
|
| Rate for Payer: PHP Commercial |
$30.72
|
| Rate for Payer: PHP Commercial |
$31.09
|
| Rate for Payer: Priority Health SBD |
$33.90
|
| Rate for Payer: Priority Health SBD |
$23.05
|
| Rate for Payer: Priority Health SBD |
$22.77
|
| Rate for Payer: Priority Health SBD |
$83.58
|
| Rate for Payer: Priority Health SBD |
$536.14
|
|
|
REHABILITATION
|
Facility
|
IP
|
$9,557.48
|
|
|
Service Code
|
APR-DRG 8601
|
| Min. Negotiated Rate |
$9,102.37 |
| Max. Negotiated Rate |
$9,557.48 |
| Rate for Payer: BCBS Complete |
$9,557.48
|
| Rate for Payer: Mclaren Medicaid |
$9,102.37
|
| Rate for Payer: Meridian Medicaid |
$9,557.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,102.37
|
| Rate for Payer: UHC Medicaid |
$9,102.37
|
| Rate for Payer: UHCCP Medicaid |
$9,102.37
|
|
|
REHABILITATION
|
Facility
|
IP
|
$12,126.44
|
|
|
Service Code
|
APR-DRG 8603
|
| Min. Negotiated Rate |
$11,548.99 |
| Max. Negotiated Rate |
$12,126.44 |
| Rate for Payer: BCBS Complete |
$12,126.44
|
| Rate for Payer: Mclaren Medicaid |
$11,548.99
|
| Rate for Payer: Meridian Medicaid |
$12,126.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,548.99
|
| Rate for Payer: UHC Medicaid |
$11,548.99
|
| Rate for Payer: UHCCP Medicaid |
$11,548.99
|
|
|
REHABILITATION
|
Facility
|
IP
|
$12,076.56
|
|
|
Service Code
|
APR-DRG 8602
|
| Min. Negotiated Rate |
$11,501.49 |
| Max. Negotiated Rate |
$12,076.56 |
| Rate for Payer: BCBS Complete |
$12,076.56
|
| Rate for Payer: Mclaren Medicaid |
$11,501.49
|
| Rate for Payer: Meridian Medicaid |
$12,076.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,501.49
|
| Rate for Payer: UHC Medicaid |
$11,501.49
|
| Rate for Payer: UHCCP Medicaid |
$11,501.49
|
|
|
REHABILITATION
|
Facility
|
IP
|
$14,243.64
|
|
|
Service Code
|
APR-DRG 8604
|
| Min. Negotiated Rate |
$13,565.37 |
| Max. Negotiated Rate |
$14,243.64 |
| Rate for Payer: BCBS Complete |
$14,243.64
|
| Rate for Payer: Mclaren Medicaid |
$13,565.37
|
| Rate for Payer: Meridian Medicaid |
$14,243.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,565.37
|
| Rate for Payer: UHC Medicaid |
$13,565.37
|
| Rate for Payer: UHCCP Medicaid |
$13,565.37
|
|
|
REHABILITATION WITH CC/MCC
|
Facility
|
IP
|
$33,520.26
|
|
|
Service Code
|
MSDRG 945
|
| Min. Negotiated Rate |
$11,919.59 |
| Max. Negotiated Rate |
$33,520.26 |
| Rate for Payer: Aetna Medicare |
$13,048.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,683.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,683.67
|
| Rate for Payer: BCBS MAPPO |
$12,546.94
|
| Rate for Payer: BCBS Trust/PPO |
$33,520.26
|
| Rate for Payer: BCN Commercial |
$33,520.26
|
| Rate for Payer: BCN Medicare Advantage |
$12,546.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,546.94
|
| Rate for Payer: Mclaren Medicare |
$12,546.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,174.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,428.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,801.63
|
| Rate for Payer: Nomi Health Commercial |
$19,976.94
|
| Rate for Payer: PACE Medicare |
$11,919.59
|
| Rate for Payer: PACE SWMI |
$12,546.94
|
| Rate for Payer: PHP Medicare Advantage |
$12,546.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,966.75
|
| Rate for Payer: Priority Health Medicare |
$12,546.94
|
| Rate for Payer: Priority Health Tiered Network |
$19,973.39
|
| Rate for Payer: Railroad Medicare Medicare |
$12,546.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,242.18
|
| Rate for Payer: UHC Core |
$21,118.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,546.94
|
| Rate for Payer: UHC Exchange |
$17,246.76
|
| Rate for Payer: VA VA |
$12,546.94
|
|
|
REHABILITATION WITHOUT CC/MCC
|
Facility
|
IP
|
$19,206.26
|
|
|
Service Code
|
MSDRG 946
|
| Min. Negotiated Rate |
$8,969.64 |
| Max. Negotiated Rate |
$19,206.26 |
| Rate for Payer: Aetna Medicare |
$9,819.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,802.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,802.16
|
| Rate for Payer: BCBS MAPPO |
$9,441.73
|
| Rate for Payer: BCBS Trust/PPO |
$19,206.26
|
| Rate for Payer: BCN Commercial |
$19,206.26
|
| Rate for Payer: BCN Medicare Advantage |
$9,441.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,441.73
|
| Rate for Payer: Mclaren Medicare |
$9,441.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,913.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,857.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,385.90
|
| Rate for Payer: Nomi Health Commercial |
$14,793.72
|
| Rate for Payer: PACE Medicare |
$8,969.64
|
| Rate for Payer: PACE SWMI |
$9,441.73
|
| Rate for Payer: PHP Medicare Advantage |
$9,441.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,488.87
|
| Rate for Payer: Priority Health Medicare |
$9,441.73
|
| Rate for Payer: Priority Health Tiered Network |
$14,791.09
|
| Rate for Payer: Railroad Medicare Medicare |
$9,441.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,692.84
|
| Rate for Payer: UHC Core |
$15,638.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,441.73
|
| Rate for Payer: UHC Exchange |
$12,771.91
|
| Rate for Payer: VA VA |
$9,441.73
|
|
|
REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT TENDON GRAFT
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 24342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,431.44 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,431.44
|
| Rate for Payer: BCN Commercial |
$3,431.44
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$3,781.35
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$2,267.62
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
300469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$2,040.86 |
| Rate for Payer: Aetna Commercial |
$1,927.48
|
| Rate for Payer: Aetna Medicare |
$7.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,473.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.62
|
| Rate for Payer: BCBS Complete |
$3.79
|
| Rate for Payer: BCBS MAPPO |
$6.90
|
| Rate for Payer: BCBS Trust/PPO |
$17.29
|
| Rate for Payer: BCN Commercial |
$17.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.90
|
| Rate for Payer: Cash Price |
$1,814.10
|
| Rate for Payer: Cash Price |
$1,814.10
|
| Rate for Payer: Cofinity Advantage |
$1,587.33
|
| Rate for Payer: Cofinity Commercial |
$1,950.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,814.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$2,040.86
|
| Rate for Payer: Mclaren Medicaid |
$3.61
|
| Rate for Payer: Mclaren Medicare |
$6.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.25
|
| Rate for Payer: Meridian Medicaid |
$7.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,927.48
|
| Rate for Payer: Nomi Health Commercial |
$20.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,700.71
|
| Rate for Payer: PACE Medicare |
$6.55
|
| Rate for Payer: PACE SWMI |
$6.90
|
| Rate for Payer: PHP Commercial |
$1,927.48
|
| Rate for Payer: PHP Medicare Advantage |
$6.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.22
|
| Rate for Payer: Priority Health Medicare |
$6.90
|
| Rate for Payer: Priority Health SBD |
$1,428.60
|
| Rate for Payer: Priority Health Tiered Network |
$16.98
|
| Rate for Payer: Railroad Medicare Medicare |
$6.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.39
|
| Rate for Payer: UHC Core |
$11.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.90
|
| Rate for Payer: UHC Exchange |
$11.39
|
| Rate for Payer: UHC Medicaid |
$3.61
|
| Rate for Payer: UHCCP Medicaid |
$3.61
|
| Rate for Payer: VA VA |
$6.90
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$2,267.62
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
300469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,428.60 |
| Max. Negotiated Rate |
$2,040.86 |
| Rate for Payer: Aetna Commercial |
$1,927.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,473.95
|
| Rate for Payer: Cash Price |
$1,814.10
|
| Rate for Payer: Cofinity Advantage |
$1,587.33
|
| Rate for Payer: Cofinity Commercial |
$1,950.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,814.10
|
| Rate for Payer: Healthscope Commercial |
$2,040.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,927.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,700.71
|
| Rate for Payer: PHP Commercial |
$1,927.48
|
| Rate for Payer: Priority Health SBD |
$1,428.60
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$229.46
|
|
|
Service Code
|
NDC 67457019800
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$144.56 |
| Max. Negotiated Rate |
$206.51 |
| Rate for Payer: Aetna Commercial |
$195.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.15
|
| Rate for Payer: Cash Price |
$183.57
|
| Rate for Payer: Cofinity Advantage |
$160.62
|
| Rate for Payer: Cofinity Commercial |
$197.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.57
|
| Rate for Payer: Healthscope Commercial |
$206.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.09
|
| Rate for Payer: PHP Commercial |
$195.04
|
| Rate for Payer: Priority Health SBD |
$144.56
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$238.60
|
|
|
Service Code
|
NDC 63323072301
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.77 |
| Max. Negotiated Rate |
$214.74 |
| Rate for Payer: Aetna Commercial |
$202.81
|
| Rate for Payer: Aetna Medicare |
$119.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.09
|
| Rate for Payer: BCBS Complete |
$95.44
|
| Rate for Payer: Cash Price |
$190.88
|
| Rate for Payer: Cofinity Advantage |
$167.02
|
| Rate for Payer: Cofinity Commercial |
$205.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.88
|
| Rate for Payer: Healthscope Commercial |
$214.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.95
|
| Rate for Payer: PHP Commercial |
$202.81
|
| Rate for Payer: Priority Health SBD |
$150.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.09
|
| Rate for Payer: UHC Core |
$124.31
|
| Rate for Payer: UHC Exchange |
$93.77
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$151.13
|
|
|
Service Code
|
NDC 00143939110
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$136.02 |
| Rate for Payer: Aetna Commercial |
$128.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.23
|
| Rate for Payer: Cash Price |
$120.90
|
| Rate for Payer: Cofinity Advantage |
$105.79
|
| Rate for Payer: Cofinity Commercial |
$129.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.90
|
| Rate for Payer: Healthscope Commercial |
$136.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.35
|
| Rate for Payer: PHP Commercial |
$128.46
|
| Rate for Payer: Priority Health SBD |
$95.21
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$151.13
|
|
|
Service Code
|
NDC 00143939110
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.39 |
| Max. Negotiated Rate |
$136.02 |
| Rate for Payer: Aetna Commercial |
$128.46
|
| Rate for Payer: Aetna Medicare |
$75.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.23
|
| Rate for Payer: BCBS Complete |
$60.45
|
| Rate for Payer: Cash Price |
$120.90
|
| Rate for Payer: Cofinity Advantage |
$105.79
|
| Rate for Payer: Cofinity Commercial |
$129.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.90
|
| Rate for Payer: Healthscope Commercial |
$136.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.35
|
| Rate for Payer: PHP Commercial |
$128.46
|
| Rate for Payer: Priority Health SBD |
$95.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.23
|
| Rate for Payer: UHC Core |
$78.74
|
| Rate for Payer: UHC Exchange |
$59.39
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$229.46
|
|
|
Service Code
|
NDC 67457019803
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$90.18 |
| Max. Negotiated Rate |
$206.51 |
| Rate for Payer: Aetna Commercial |
$195.04
|
| Rate for Payer: Aetna Medicare |
$114.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.15
|
| Rate for Payer: BCBS Complete |
$91.78
|
| Rate for Payer: Cash Price |
$183.57
|
| Rate for Payer: Cofinity Advantage |
$160.62
|
| Rate for Payer: Cofinity Commercial |
$197.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.57
|
| Rate for Payer: Healthscope Commercial |
$206.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$183.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.09
|
| Rate for Payer: PHP Commercial |
$195.04
|
| Rate for Payer: Priority Health SBD |
$144.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.15
|
| Rate for Payer: UHC Core |
$119.55
|
| Rate for Payer: UHC Exchange |
$90.18
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$238.60
|
|
|
Service Code
|
NDC 63323072301
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$150.32 |
| Max. Negotiated Rate |
$214.74 |
| Rate for Payer: Aetna Commercial |
$202.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.09
|
| Rate for Payer: Cash Price |
$190.88
|
| Rate for Payer: Cofinity Advantage |
$167.02
|
| Rate for Payer: Cofinity Commercial |
$205.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.88
|
| Rate for Payer: Healthscope Commercial |
$214.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.95
|
| Rate for Payer: PHP Commercial |
$202.81
|
| Rate for Payer: Priority Health SBD |
$150.32
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$229.46
|
|
|
Service Code
|
NDC 67457019803
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$144.56 |
| Max. Negotiated Rate |
$206.51 |
| Rate for Payer: Aetna Commercial |
$195.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.15
|
| Rate for Payer: Cash Price |
$183.57
|
| Rate for Payer: Cofinity Advantage |
$160.62
|
| Rate for Payer: Cofinity Commercial |
$197.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.57
|
| Rate for Payer: Healthscope Commercial |
$206.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.09
|
| Rate for Payer: PHP Commercial |
$195.04
|
| Rate for Payer: Priority Health SBD |
$144.56
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$151.13
|
|
|
Service Code
|
NDC 00143939101
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$136.02 |
| Rate for Payer: Aetna Commercial |
$128.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.23
|
| Rate for Payer: Cash Price |
$120.90
|
| Rate for Payer: Cofinity Advantage |
$105.79
|
| Rate for Payer: Cofinity Commercial |
$129.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.90
|
| Rate for Payer: Healthscope Commercial |
$136.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.35
|
| Rate for Payer: PHP Commercial |
$128.46
|
| Rate for Payer: Priority Health SBD |
$95.21
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$238.60
|
|
|
Service Code
|
NDC 63323072303
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.77 |
| Max. Negotiated Rate |
$214.74 |
| Rate for Payer: Aetna Commercial |
$202.81
|
| Rate for Payer: Aetna Medicare |
$119.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.09
|
| Rate for Payer: BCBS Complete |
$95.44
|
| Rate for Payer: Cash Price |
$190.88
|
| Rate for Payer: Cofinity Advantage |
$167.02
|
| Rate for Payer: Cofinity Commercial |
$205.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.88
|
| Rate for Payer: Healthscope Commercial |
$214.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.95
|
| Rate for Payer: PHP Commercial |
$202.81
|
| Rate for Payer: Priority Health SBD |
$150.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.09
|
| Rate for Payer: UHC Core |
$124.31
|
| Rate for Payer: UHC Exchange |
$93.77
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$229.46
|
|
|
Service Code
|
NDC 67457019800
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$90.18 |
| Max. Negotiated Rate |
$206.51 |
| Rate for Payer: Aetna Commercial |
$195.04
|
| Rate for Payer: Aetna Medicare |
$114.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.15
|
| Rate for Payer: BCBS Complete |
$91.78
|
| Rate for Payer: Cash Price |
$183.57
|
| Rate for Payer: Cofinity Advantage |
$160.62
|
| Rate for Payer: Cofinity Commercial |
$197.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.57
|
| Rate for Payer: Healthscope Commercial |
$206.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$183.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.09
|
| Rate for Payer: PHP Commercial |
$195.04
|
| Rate for Payer: Priority Health SBD |
$144.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.15
|
| Rate for Payer: UHC Core |
$119.55
|
| Rate for Payer: UHC Exchange |
$90.18
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$151.13
|
|
|
Service Code
|
NDC 00143939101
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.39 |
| Max. Negotiated Rate |
$136.02 |
| Rate for Payer: Aetna Commercial |
$128.46
|
| Rate for Payer: Aetna Medicare |
$75.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.23
|
| Rate for Payer: BCBS Complete |
$60.45
|
| Rate for Payer: Cash Price |
$120.90
|
| Rate for Payer: Cofinity Advantage |
$105.79
|
| Rate for Payer: Cofinity Commercial |
$129.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.90
|
| Rate for Payer: Healthscope Commercial |
$136.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.35
|
| Rate for Payer: PHP Commercial |
$128.46
|
| Rate for Payer: Priority Health SBD |
$95.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.23
|
| Rate for Payer: UHC Core |
$78.74
|
| Rate for Payer: UHC Exchange |
$59.39
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$238.60
|
|
|
Service Code
|
NDC 63323072303
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$150.32 |
| Max. Negotiated Rate |
$214.74 |
| Rate for Payer: Aetna Commercial |
$202.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.09
|
| Rate for Payer: Cash Price |
$190.88
|
| Rate for Payer: Cofinity Advantage |
$167.02
|
| Rate for Payer: Cofinity Commercial |
$205.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.88
|
| Rate for Payer: Healthscope Commercial |
$214.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.95
|
| Rate for Payer: PHP Commercial |
$202.81
|
| Rate for Payer: Priority Health SBD |
$150.32
|
|
|
REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITH GENERAL ANESTHESIA
|
Facility
|
OP
|
$5,321.93
|
|
|
Service Code
|
CPT 69205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,433.40
|
| Rate for Payer: BCN Commercial |
$1,433.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Mclaren Medicaid |
$860.68
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL
|
Facility
|
OP
|
$190.09
|
|
|
Service Code
|
CPT 69210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$79.24
|
| Rate for Payer: BCN Commercial |
$79.24
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Mclaren Medicaid |
$30.74
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL
|
Facility
|
OP
|
$190.09
|
|
|
Service Code
|
CPT 69209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$51.91
|
| Rate for Payer: BCN Commercial |
$51.91
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Mclaren Medicaid |
$30.74
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
