|
SPIRONOLACTONE 50 MG TABLET
|
Facility
|
IP
|
$290.70
|
|
|
Service Code
|
NDC 63739054510
|
| Hospital Charge Code |
11426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.14 |
| Max. Negotiated Rate |
$261.63 |
| Rate for Payer: Aetna Commercial |
$247.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.96
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Advantage |
$203.49
|
| Rate for Payer: Cofinity Commercial |
$250.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Healthscope Commercial |
$261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.03
|
| Rate for Payer: PHP Commercial |
$247.09
|
| Rate for Payer: Priority Health SBD |
$183.14
|
|
|
SPIRONOLACTONE 50 MG TABLET
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
NDC 60687047601
|
| Hospital Charge Code |
11426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.54 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Aetna Commercial |
$226.10
|
| Rate for Payer: Aetna Medicare |
$133.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.90
|
| Rate for Payer: BCBS Complete |
$106.40
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cofinity Advantage |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$228.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.80
|
| Rate for Payer: Healthscope Commercial |
$239.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.50
|
| Rate for Payer: PHP Commercial |
$226.10
|
| Rate for Payer: Priority Health SBD |
$167.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.90
|
| Rate for Payer: UHC Core |
$138.59
|
| Rate for Payer: UHC Exchange |
$104.54
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$16,591.88
|
|
|
Service Code
|
APR-DRG 6503
|
| Min. Negotiated Rate |
$15,801.79 |
| Max. Negotiated Rate |
$16,591.88 |
| Rate for Payer: BCBS Complete |
$16,591.88
|
| Rate for Payer: Mclaren Medicaid |
$15,801.79
|
| Rate for Payer: Meridian Medicaid |
$16,591.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,801.79
|
| Rate for Payer: UHC Medicaid |
$15,801.79
|
| Rate for Payer: UHCCP Medicaid |
$15,801.79
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$23,340.19
|
|
|
Service Code
|
APR-DRG 6504
|
| Min. Negotiated Rate |
$22,228.75 |
| Max. Negotiated Rate |
$23,340.19 |
| Rate for Payer: BCBS Complete |
$23,340.19
|
| Rate for Payer: Mclaren Medicaid |
$22,228.75
|
| Rate for Payer: Meridian Medicaid |
$23,340.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,228.75
|
| Rate for Payer: UHC Medicaid |
$22,228.75
|
| Rate for Payer: UHCCP Medicaid |
$22,228.75
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$9,672.14
|
|
|
Service Code
|
APR-DRG 6501
|
| Min. Negotiated Rate |
$9,211.57 |
| Max. Negotiated Rate |
$9,672.14 |
| Rate for Payer: BCBS Complete |
$9,672.14
|
| Rate for Payer: Mclaren Medicaid |
$9,211.57
|
| Rate for Payer: Meridian Medicaid |
$9,672.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,211.57
|
| Rate for Payer: UHC Medicaid |
$9,211.57
|
| Rate for Payer: UHCCP Medicaid |
$9,211.57
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$13,217.43
|
|
|
Service Code
|
APR-DRG 6502
|
| Min. Negotiated Rate |
$12,588.03 |
| Max. Negotiated Rate |
$13,217.43 |
| Rate for Payer: BCBS Complete |
$13,217.43
|
| Rate for Payer: Mclaren Medicaid |
$12,588.03
|
| Rate for Payer: Meridian Medicaid |
$13,217.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,588.03
|
| Rate for Payer: UHC Medicaid |
$12,588.03
|
| Rate for Payer: UHCCP Medicaid |
$12,588.03
|
|
|
SPLENIC PROCEDURES WITH CC
|
Facility
|
IP
|
$45,793.22
|
|
|
Service Code
|
MSDRG 800
|
| Min. Negotiated Rate |
$21,176.16 |
| Max. Negotiated Rate |
$45,793.22 |
| Rate for Payer: Aetna Medicare |
$23,182.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,863.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,863.36
|
| Rate for Payer: BCBS MAPPO |
$22,290.69
|
| Rate for Payer: BCBS Trust/PPO |
$45,001.88
|
| Rate for Payer: BCN Commercial |
$45,001.88
|
| Rate for Payer: BCN Medicare Advantage |
$22,290.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,290.69
|
| Rate for Payer: Mclaren Medicare |
$22,290.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,405.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,634.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$24,519.76
|
| Rate for Payer: Nomi Health Commercial |
$36,241.26
|
| Rate for Payer: PACE Medicare |
$21,176.16
|
| Rate for Payer: PACE SWMI |
$22,290.69
|
| Rate for Payer: PHP Medicare Advantage |
$22,290.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$45,293.54
|
| Rate for Payer: Priority Health Medicare |
$22,290.69
|
| Rate for Payer: Priority Health Tiered Network |
$36,234.83
|
| Rate for Payer: Railroad Medicare Medicare |
$22,290.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45,793.22
|
| Rate for Payer: UHC Core |
$38,311.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22,290.69
|
| Rate for Payer: UHC Exchange |
$31,288.29
|
| Rate for Payer: VA VA |
$22,290.69
|
|
|
SPLENIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$73,821.07
|
|
|
Service Code
|
MSDRG 799
|
| Min. Negotiated Rate |
$33,800.41 |
| Max. Negotiated Rate |
$73,821.07 |
| Rate for Payer: Aetna Medicare |
$37,002.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44,474.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44,474.22
|
| Rate for Payer: BCBS MAPPO |
$35,579.38
|
| Rate for Payer: BCBS Trust/PPO |
$61,843.94
|
| Rate for Payer: BCN Commercial |
$61,843.94
|
| Rate for Payer: BCN Medicare Advantage |
$35,579.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,579.38
|
| Rate for Payer: Mclaren Medicare |
$35,579.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37,358.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40,916.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$39,137.32
|
| Rate for Payer: Nomi Health Commercial |
$58,422.81
|
| Rate for Payer: PACE Medicare |
$33,800.41
|
| Rate for Payer: PACE SWMI |
$35,579.38
|
| Rate for Payer: PHP Medicare Advantage |
$35,579.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$73,015.56
|
| Rate for Payer: Priority Health Medicare |
$35,579.38
|
| Rate for Payer: Priority Health Tiered Network |
$58,412.44
|
| Rate for Payer: Railroad Medicare Medicare |
$35,579.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73,821.07
|
| Rate for Payer: UHC Core |
$61,760.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35,579.38
|
| Rate for Payer: UHC Exchange |
$50,438.36
|
| Rate for Payer: VA VA |
$35,579.38
|
|
|
SPLENIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$43,548.24
|
|
|
Service Code
|
MSDRG 801
|
| Min. Negotiated Rate |
$14,564.85 |
| Max. Negotiated Rate |
$43,548.24 |
| Rate for Payer: BCBS Trust/PPO |
$43,548.24
|
| Rate for Payer: Aetna Medicare |
$15,944.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,164.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,164.28
|
| Rate for Payer: BCBS MAPPO |
$15,331.42
|
| Rate for Payer: BCN Commercial |
$43,548.24
|
| Rate for Payer: BCN Medicare Advantage |
$15,331.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,331.42
|
| Rate for Payer: Mclaren Medicare |
$15,331.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,097.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,631.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,864.56
|
| Rate for Payer: Nomi Health Commercial |
$24,624.81
|
| Rate for Payer: PACE Medicare |
$14,564.85
|
| Rate for Payer: PACE SWMI |
$15,331.42
|
| Rate for Payer: PHP Medicare Advantage |
$15,331.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30,775.55
|
| Rate for Payer: Priority Health Medicare |
$15,331.42
|
| Rate for Payer: Priority Health Tiered Network |
$24,620.44
|
| Rate for Payer: Railroad Medicare Medicare |
$15,331.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,115.07
|
| Rate for Payer: UHC Core |
$26,031.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,331.42
|
| Rate for Payer: UHC Exchange |
$21,259.42
|
| Rate for Payer: VA VA |
$15,331.42
|
|
|
SPLIT-THICKNESS AUTOGRAFT, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDITIONAL 1% OF BODY AREA OF INFANTS AND CHILDREN, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,048.80
|
|
|
Service Code
|
CPT 15101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,048.80 |
| Max. Negotiated Rate |
$1,048.80 |
| Rate for Payer: BCBS Trust/PPO |
$1,048.80
|
| Rate for Payer: BCN Commercial |
$1,048.80
|
|
|
SPLIT-THICKNESS AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR 1% OF BODY AREA OF INFANTS AND CHILDREN (EXCEPT 15050)
|
Facility
|
OP
|
$6,648.46
|
|
|
Service Code
|
CPT 15100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,896.26
|
| Rate for Payer: BCN Commercial |
$2,896.26
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Mclaren Medicaid |
$1,075.21
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC
|
Facility
|
IP
|
$28,466.47
|
|
|
Service Code
|
MSDRG 537
|
| Min. Negotiated Rate |
$7,556.36 |
| Max. Negotiated Rate |
$28,466.47 |
| Rate for Payer: Aetna Medicare |
$8,272.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,942.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,942.58
|
| Rate for Payer: BCBS MAPPO |
$7,954.06
|
| Rate for Payer: BCBS Trust/PPO |
$28,466.47
|
| Rate for Payer: BCN Commercial |
$28,466.47
|
| Rate for Payer: BCN Medicare Advantage |
$7,954.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,954.06
|
| Rate for Payer: Mclaren Medicare |
$7,954.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,351.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,147.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,749.47
|
| Rate for Payer: Nomi Health Commercial |
$12,310.47
|
| Rate for Payer: PACE Medicare |
$7,556.36
|
| Rate for Payer: PACE SWMI |
$7,954.06
|
| Rate for Payer: PHP Medicare Advantage |
$7,954.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,385.36
|
| Rate for Payer: Priority Health Medicare |
$7,954.06
|
| Rate for Payer: Priority Health Tiered Network |
$12,308.28
|
| Rate for Payer: Railroad Medicare Medicare |
$7,954.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,555.09
|
| Rate for Payer: UHC Core |
$13,013.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,954.06
|
| Rate for Payer: UHC Exchange |
$10,628.04
|
| Rate for Payer: VA VA |
$7,954.06
|
|
|
SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC
|
Facility
|
IP
|
$14,356.13
|
|
|
Service Code
|
MSDRG 538
|
| Min. Negotiated Rate |
$5,838.36 |
| Max. Negotiated Rate |
$14,356.13 |
| Rate for Payer: Aetna Medicare |
$6,391.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,682.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,682.05
|
| Rate for Payer: BCBS MAPPO |
$6,145.64
|
| Rate for Payer: BCBS Trust/PPO |
$14,356.13
|
| Rate for Payer: BCN Commercial |
$14,356.13
|
| Rate for Payer: BCN Medicare Advantage |
$6,145.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,145.64
|
| Rate for Payer: Mclaren Medicare |
$6,145.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,452.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,067.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,760.20
|
| Rate for Payer: Nomi Health Commercial |
$9,291.87
|
| Rate for Payer: PACE Medicare |
$5,838.36
|
| Rate for Payer: PACE SWMI |
$6,145.64
|
| Rate for Payer: PHP Medicare Advantage |
$6,145.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,612.78
|
| Rate for Payer: Priority Health Medicare |
$6,145.64
|
| Rate for Payer: Priority Health Tiered Network |
$9,290.22
|
| Rate for Payer: Railroad Medicare Medicare |
$6,145.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,740.89
|
| Rate for Payer: UHC Core |
$9,822.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,145.64
|
| Rate for Payer: UHC Exchange |
$8,021.98
|
| Rate for Payer: VA VA |
$6,145.64
|
|
|
STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; MORE THAN 20 INCISIONS
|
Facility
|
OP
|
$10,174.29
|
|
|
Service Code
|
CPT 37766
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$368.27 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$368.27
|
| Rate for Payer: BCN Commercial |
$368.27
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
STEREOTACTIC COMPUTER-ASSISTED (NAVIGATIONAL) PROCEDURE; CRANIAL, EXTRADURAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$470.91
|
|
|
Service Code
|
CPT 61782
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$470.91 |
| Max. Negotiated Rate |
$470.91 |
| Rate for Payer: BCBS Trust/PPO |
$470.91
|
| Rate for Payer: BCN Commercial |
$470.91
|
|
|
STEREOTACTIC COMPUTER-ASSISTED (NAVIGATIONAL) PROCEDURE; SPINAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$634.37
|
|
|
Service Code
|
CPT 61783
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$634.37 |
| Max. Negotiated Rate |
$634.37 |
| Rate for Payer: BCBS Trust/PPO |
$634.37
|
| Rate for Payer: BCN Commercial |
$634.37
|
|
|
STERILE TALC 3 GRAM INTRAPLEURAL AEROSOL POWDER
|
Facility
|
OP
|
$443.75
|
|
|
Service Code
|
NDC 62327033343
|
| Hospital Charge Code |
186167
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$174.39 |
| Max. Negotiated Rate |
$399.38 |
| Rate for Payer: Aetna Commercial |
$377.19
|
| Rate for Payer: Aetna Medicare |
$221.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.44
|
| Rate for Payer: BCBS Complete |
$177.50
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cofinity Advantage |
$310.62
|
| Rate for Payer: Cofinity Commercial |
$381.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.00
|
| Rate for Payer: Healthscope Commercial |
$399.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$355.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.81
|
| Rate for Payer: PHP Commercial |
$377.19
|
| Rate for Payer: Priority Health SBD |
$279.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.44
|
| Rate for Payer: UHC Core |
$231.19
|
| Rate for Payer: UHC Exchange |
$174.39
|
|
|
STERILE TALC 3 GRAM INTRAPLEURAL AEROSOL POWDER
|
Facility
|
IP
|
$443.75
|
|
|
Service Code
|
NDC 62327033303
|
| Hospital Charge Code |
186167
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$279.56 |
| Max. Negotiated Rate |
$399.38 |
| Rate for Payer: Aetna Commercial |
$377.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.44
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cofinity Advantage |
$310.62
|
| Rate for Payer: Cofinity Commercial |
$381.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.00
|
| Rate for Payer: Healthscope Commercial |
$399.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.81
|
| Rate for Payer: PHP Commercial |
$377.19
|
| Rate for Payer: Priority Health SBD |
$279.56
|
|
|
STERILE TALC 3 GRAM INTRAPLEURAL AEROSOL POWDER
|
Facility
|
IP
|
$443.75
|
|
|
Service Code
|
NDC 62327033343
|
| Hospital Charge Code |
186167
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$279.56 |
| Max. Negotiated Rate |
$399.38 |
| Rate for Payer: Aetna Commercial |
$377.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.44
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cofinity Advantage |
$310.62
|
| Rate for Payer: Cofinity Commercial |
$381.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.00
|
| Rate for Payer: Healthscope Commercial |
$399.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.81
|
| Rate for Payer: PHP Commercial |
$377.19
|
| Rate for Payer: Priority Health SBD |
$279.56
|
|
|
STERILE TALC 3 GRAM INTRAPLEURAL AEROSOL POWDER
|
Facility
|
OP
|
$443.75
|
|
|
Service Code
|
NDC 62327033303
|
| Hospital Charge Code |
186167
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$174.39 |
| Max. Negotiated Rate |
$399.38 |
| Rate for Payer: Aetna Commercial |
$377.19
|
| Rate for Payer: Aetna Medicare |
$221.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.44
|
| Rate for Payer: BCBS Complete |
$177.50
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cofinity Advantage |
$310.62
|
| Rate for Payer: Cofinity Commercial |
$381.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.00
|
| Rate for Payer: Healthscope Commercial |
$399.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$355.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.81
|
| Rate for Payer: PHP Commercial |
$377.19
|
| Rate for Payer: Priority Health SBD |
$279.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.44
|
| Rate for Payer: UHC Core |
$231.19
|
| Rate for Payer: UHC Exchange |
$174.39
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC
|
Facility
|
IP
|
$45,205.53
|
|
|
Service Code
|
MSDRG 327
|
| Min. Negotiated Rate |
$18,494.90 |
| Max. Negotiated Rate |
$45,205.53 |
| Rate for Payer: Aetna Medicare |
$20,247.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,335.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,335.40
|
| Rate for Payer: BCBS MAPPO |
$19,468.32
|
| Rate for Payer: BCBS Trust/PPO |
$45,205.53
|
| Rate for Payer: BCN Commercial |
$45,205.53
|
| Rate for Payer: BCN Medicare Advantage |
$19,468.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,468.32
|
| Rate for Payer: Mclaren Medicare |
$19,468.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,441.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,388.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$21,415.15
|
| Rate for Payer: Nomi Health Commercial |
$31,530.18
|
| Rate for Payer: PACE Medicare |
$18,494.90
|
| Rate for Payer: PACE SWMI |
$19,468.32
|
| Rate for Payer: PHP Medicare Advantage |
$19,468.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$39,405.73
|
| Rate for Payer: Priority Health Medicare |
$19,468.32
|
| Rate for Payer: Priority Health Tiered Network |
$31,524.58
|
| Rate for Payer: Railroad Medicare Medicare |
$19,468.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39,840.46
|
| Rate for Payer: UHC Core |
$33,331.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,468.32
|
| Rate for Payer: UHC Exchange |
$27,221.06
|
| Rate for Payer: VA VA |
$19,468.32
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$84,727.60
|
|
|
Service Code
|
MSDRG 326
|
| Min. Negotiated Rate |
$37,166.63 |
| Max. Negotiated Rate |
$84,727.60 |
| Rate for Payer: Aetna Medicare |
$40,687.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48,903.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48,903.46
|
| Rate for Payer: BCBS MAPPO |
$39,122.77
|
| Rate for Payer: BCBS Trust/PPO |
$84,727.60
|
| Rate for Payer: BCN Commercial |
$84,727.60
|
| Rate for Payer: BCN Medicare Advantage |
$39,122.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39,122.77
|
| Rate for Payer: Mclaren Medicare |
$39,122.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41,078.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44,991.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$43,035.05
|
| Rate for Payer: Nomi Health Commercial |
$64,337.46
|
| Rate for Payer: PACE Medicare |
$37,166.63
|
| Rate for Payer: PACE SWMI |
$39,122.77
|
| Rate for Payer: PHP Medicare Advantage |
$39,122.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$80,407.56
|
| Rate for Payer: Priority Health Medicare |
$39,122.77
|
| Rate for Payer: Priority Health Tiered Network |
$64,326.04
|
| Rate for Payer: Railroad Medicare Medicare |
$39,122.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81,294.62
|
| Rate for Payer: UHC Core |
$68,013.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$39,122.77
|
| Rate for Payer: UHC Exchange |
$55,544.67
|
| Rate for Payer: VA VA |
$39,122.77
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$29,824.13
|
|
|
Service Code
|
MSDRG 328
|
| Min. Negotiated Rate |
$12,313.83 |
| Max. Negotiated Rate |
$29,824.13 |
| Rate for Payer: Aetna Medicare |
$13,480.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,202.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,202.41
|
| Rate for Payer: BCBS MAPPO |
$12,961.93
|
| Rate for Payer: BCBS Trust/PPO |
$29,824.13
|
| Rate for Payer: BCN Commercial |
$29,824.13
|
| Rate for Payer: BCN Medicare Advantage |
$12,961.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,961.93
|
| Rate for Payer: Mclaren Medicare |
$12,961.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,610.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,906.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,258.12
|
| Rate for Payer: Nomi Health Commercial |
$20,669.67
|
| Rate for Payer: PACE Medicare |
$12,313.83
|
| Rate for Payer: PACE SWMI |
$12,961.93
|
| Rate for Payer: PHP Medicare Advantage |
$12,961.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25,832.50
|
| Rate for Payer: Priority Health Medicare |
$12,961.93
|
| Rate for Payer: Priority Health Tiered Network |
$20,666.00
|
| Rate for Payer: Railroad Medicare Medicare |
$12,961.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,117.49
|
| Rate for Payer: UHC Core |
$21,850.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,961.93
|
| Rate for Payer: UHC Exchange |
$17,844.82
|
| Rate for Payer: VA VA |
$12,961.93
|
|
|
SUBMUCOSAL INJECTABLE COMPOSITION (ELEVIEW)
|
Facility
|
OP
|
$287.55
|
|
|
Service Code
|
NDC 09900001087
|
| Hospital Charge Code |
200133
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.01 |
| Max. Negotiated Rate |
$258.80 |
| Rate for Payer: Aetna Commercial |
$244.42
|
| Rate for Payer: Aetna Medicare |
$143.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.91
|
| Rate for Payer: BCBS Complete |
$115.02
|
| Rate for Payer: Cash Price |
$230.04
|
| Rate for Payer: Cofinity Advantage |
$201.28
|
| Rate for Payer: Cofinity Commercial |
$247.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.04
|
| Rate for Payer: Healthscope Commercial |
$258.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$230.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.66
|
| Rate for Payer: PHP Commercial |
$244.42
|
| Rate for Payer: Priority Health SBD |
$181.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.91
|
| Rate for Payer: UHC Core |
$149.81
|
| Rate for Payer: UHC Exchange |
$113.01
|
|
|
SUBMUCOSAL INJECTABLE COMPOSITION (ELEVIEW)
|
Facility
|
IP
|
$287.55
|
|
|
Service Code
|
NDC 09900001087
|
| Hospital Charge Code |
200133
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$181.16 |
| Max. Negotiated Rate |
$258.80 |
| Rate for Payer: Aetna Commercial |
$244.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.91
|
| Rate for Payer: Cash Price |
$230.04
|
| Rate for Payer: Cofinity Advantage |
$201.28
|
| Rate for Payer: Cofinity Commercial |
$247.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.04
|
| Rate for Payer: Healthscope Commercial |
$258.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.66
|
| Rate for Payer: PHP Commercial |
$244.42
|
| Rate for Payer: Priority Health SBD |
$181.16
|
|
