|
SUMATRIPTAN 50 MG TABLET
|
Facility
|
OP
|
$7.92
|
|
|
Service Code
|
NDC 55111029209
|
| Hospital Charge Code |
15328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Aetna Commercial |
$6.73
|
| Rate for Payer: Aetna Medicare |
$3.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.15
|
| Rate for Payer: BCBS Complete |
$3.17
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cofinity Advantage |
$5.54
|
| Rate for Payer: Cofinity Commercial |
$6.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.34
|
| Rate for Payer: Healthscope Commercial |
$7.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.94
|
| Rate for Payer: PHP Commercial |
$6.73
|
| Rate for Payer: Priority Health SBD |
$4.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.15
|
| Rate for Payer: UHC Core |
$4.13
|
| Rate for Payer: UHC Exchange |
$3.11
|
|
|
SUMATRIPTAN 50 MG TABLET
|
Facility
|
OP
|
$71.20
|
|
|
Service Code
|
NDC 62756052169
|
| Hospital Charge Code |
15328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.98 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Aetna Commercial |
$60.52
|
| Rate for Payer: Aetna Medicare |
$35.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.28
|
| Rate for Payer: BCBS Complete |
$28.48
|
| Rate for Payer: Cash Price |
$56.96
|
| Rate for Payer: Cofinity Advantage |
$49.84
|
| Rate for Payer: Cofinity Commercial |
$61.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.96
|
| Rate for Payer: Healthscope Commercial |
$64.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.40
|
| Rate for Payer: PHP Commercial |
$60.52
|
| Rate for Payer: Priority Health SBD |
$44.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.28
|
| Rate for Payer: UHC Core |
$37.10
|
| Rate for Payer: UHC Exchange |
$27.98
|
|
|
SUMATRIPTAN 50 MG TABLET
|
Facility
|
IP
|
$34.55
|
|
|
Service Code
|
NDC 65862014736
|
| Hospital Charge Code |
15328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$31.09 |
| Rate for Payer: Aetna Commercial |
$29.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.46
|
| Rate for Payer: Cash Price |
$27.64
|
| Rate for Payer: Cofinity Advantage |
$24.18
|
| Rate for Payer: Cofinity Commercial |
$29.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$31.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.91
|
| Rate for Payer: PHP Commercial |
$29.37
|
| Rate for Payer: Priority Health SBD |
$21.77
|
|
|
SUMATRIPTAN 50 MG TABLET
|
Facility
|
OP
|
$34.55
|
|
|
Service Code
|
NDC 65862014736
|
| Hospital Charge Code |
15328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$31.09 |
| Rate for Payer: Aetna Commercial |
$29.37
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.46
|
| Rate for Payer: BCBS Complete |
$13.82
|
| Rate for Payer: Cash Price |
$27.64
|
| Rate for Payer: Cofinity Advantage |
$24.18
|
| Rate for Payer: Cofinity Commercial |
$29.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$31.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.91
|
| Rate for Payer: PHP Commercial |
$29.37
|
| Rate for Payer: Priority Health SBD |
$21.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.46
|
| Rate for Payer: UHC Core |
$18.00
|
| Rate for Payer: UHC Exchange |
$13.58
|
|
|
SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$20.70
|
|
|
Service Code
|
HCPCS J3030
|
| Hospital Charge Code |
97342
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Commercial |
$22.42
|
| Rate for Payer: Aetna Commercial |
$42.04
|
| Rate for Payer: Aetna Commercial |
$23.11
|
| Rate for Payer: Aetna Commercial |
$21.15
|
| Rate for Payer: Aetna Commercial |
$88.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.15
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cash Price |
$19.90
|
| Rate for Payer: Cash Price |
$39.57
|
| Rate for Payer: Cash Price |
$83.26
|
| Rate for Payer: Cofinity Advantage |
$18.47
|
| Rate for Payer: Cofinity Advantage |
$72.85
|
| Rate for Payer: Cofinity Advantage |
$34.62
|
| Rate for Payer: Cofinity Advantage |
$14.49
|
| Rate for Payer: Cofinity Advantage |
$19.03
|
| Rate for Payer: Cofinity Advantage |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$89.50
|
| Rate for Payer: Cofinity Commercial |
$21.40
|
| Rate for Payer: Cofinity Commercial |
$42.54
|
| Rate for Payer: Cofinity Commercial |
$22.69
|
| Rate for Payer: Cofinity Commercial |
$23.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.57
|
| Rate for Payer: Healthscope Commercial |
$93.66
|
| Rate for Payer: Healthscope Commercial |
$24.47
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$23.74
|
| Rate for Payer: Healthscope Commercial |
$22.39
|
| Rate for Payer: Healthscope Commercial |
$44.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.79
|
| Rate for Payer: PHP Commercial |
$22.42
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$23.11
|
| Rate for Payer: PHP Commercial |
$21.15
|
| Rate for Payer: PHP Commercial |
$88.46
|
| Rate for Payer: PHP Commercial |
$42.04
|
| Rate for Payer: Priority Health SBD |
$15.67
|
| Rate for Payer: Priority Health SBD |
$16.62
|
| Rate for Payer: Priority Health SBD |
$17.13
|
| Rate for Payer: Priority Health SBD |
$65.56
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: Priority Health SBD |
$31.16
|
|
|
SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$27.19
|
|
|
Service Code
|
HCPCS J3030
|
| Hospital Charge Code |
97342
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$312.68 |
| Rate for Payer: Aetna Commercial |
$23.11
|
| Rate for Payer: Aetna Commercial |
$88.46
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Commercial |
$21.15
|
| Rate for Payer: Aetna Commercial |
$42.04
|
| Rate for Payer: Aetna Commercial |
$22.42
|
| Rate for Payer: Aetna Medicare |
$13.60
|
| Rate for Payer: Aetna Medicare |
$12.44
|
| Rate for Payer: Aetna Medicare |
$10.35
|
| Rate for Payer: Aetna Medicare |
$52.03
|
| Rate for Payer: Aetna Medicare |
$24.73
|
| Rate for Payer: Aetna Medicare |
$13.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.67
|
| Rate for Payer: BCBS Complete |
$9.95
|
| Rate for Payer: BCBS Complete |
$19.78
|
| Rate for Payer: BCBS Complete |
$10.88
|
| Rate for Payer: BCBS Complete |
$41.63
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS Trust/PPO |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$12.31
|
| Rate for Payer: BCN Commercial |
$12.31
|
| Rate for Payer: BCN Commercial |
$12.31
|
| Rate for Payer: BCN Commercial |
$12.31
|
| Rate for Payer: BCN Commercial |
$12.31
|
| Rate for Payer: BCN Commercial |
$12.31
|
| Rate for Payer: BCN Commercial |
$12.31
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cash Price |
$39.57
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$39.57
|
| Rate for Payer: Cash Price |
$21.10
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$83.26
|
| Rate for Payer: Cash Price |
$83.26
|
| Rate for Payer: Cash Price |
$19.90
|
| Rate for Payer: Cash Price |
$19.90
|
| Rate for Payer: Cofinity Advantage |
$72.85
|
| Rate for Payer: Cofinity Advantage |
$17.42
|
| Rate for Payer: Cofinity Advantage |
$18.47
|
| Rate for Payer: Cofinity Advantage |
$14.49
|
| Rate for Payer: Cofinity Advantage |
$19.03
|
| Rate for Payer: Cofinity Advantage |
$34.62
|
| Rate for Payer: Cofinity Commercial |
$21.40
|
| Rate for Payer: Cofinity Commercial |
$89.50
|
| Rate for Payer: Cofinity Commercial |
$42.54
|
| Rate for Payer: Cofinity Commercial |
$23.38
|
| Rate for Payer: Cofinity Commercial |
$22.69
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.10
|
| Rate for Payer: Healthscope Commercial |
$23.74
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$22.39
|
| Rate for Payer: Healthscope Commercial |
$93.66
|
| Rate for Payer: Healthscope Commercial |
$24.47
|
| Rate for Payer: Healthscope Commercial |
$44.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.66
|
| Rate for Payer: PHP Commercial |
$88.46
|
| Rate for Payer: PHP Commercial |
$42.04
|
| Rate for Payer: PHP Commercial |
$22.42
|
| Rate for Payer: PHP Commercial |
$21.15
|
| Rate for Payer: PHP Commercial |
$23.11
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$39.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$39.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$39.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$39.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$39.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$39.22
|
| Rate for Payer: Priority Health SBD |
$15.67
|
| Rate for Payer: Priority Health SBD |
$17.13
|
| Rate for Payer: Priority Health SBD |
$65.56
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: Priority Health SBD |
$16.62
|
| Rate for Payer: Priority Health SBD |
$31.16
|
| Rate for Payer: Priority Health Tiered Network |
$31.38
|
| Rate for Payer: Priority Health Tiered Network |
$31.38
|
| Rate for Payer: Priority Health Tiered Network |
$31.38
|
| Rate for Payer: Priority Health Tiered Network |
$31.38
|
| Rate for Payer: Priority Health Tiered Network |
$31.38
|
| Rate for Payer: Priority Health Tiered Network |
$31.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.68
|
| Rate for Payer: UHC Core |
$312.68
|
| Rate for Payer: UHC Core |
$312.68
|
| Rate for Payer: UHC Core |
$312.68
|
| Rate for Payer: UHC Core |
$312.68
|
| Rate for Payer: UHC Core |
$312.68
|
| Rate for Payer: UHC Core |
$312.68
|
| Rate for Payer: UHC Exchange |
$312.68
|
| Rate for Payer: UHC Exchange |
$312.68
|
| Rate for Payer: UHC Exchange |
$312.68
|
| Rate for Payer: UHC Exchange |
$312.68
|
| Rate for Payer: UHC Exchange |
$312.68
|
| Rate for Payer: UHC Exchange |
$312.68
|
|
|
SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); INTERSPHINCTERIC
|
Facility
|
OP
|
$8,943.95
|
|
|
Service Code
|
CPT 46275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,446.45 |
| Max. Negotiated Rate |
$8,943.95 |
| Rate for Payer: Aetna Medicare |
$2,876.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,457.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,457.10
|
| Rate for Payer: BCBS Complete |
$1,518.91
|
| Rate for Payer: BCBS MAPPO |
$2,765.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,719.05
|
| Rate for Payer: BCN Commercial |
$1,719.05
|
| Rate for Payer: BCN Medicare Advantage |
$2,765.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,765.68
|
| Rate for Payer: Mclaren Medicaid |
$1,446.45
|
| Rate for Payer: Mclaren Medicare |
$2,765.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,903.96
|
| Rate for Payer: Meridian Medicaid |
$2,903.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,180.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,042.25
|
| Rate for Payer: Nomi Health Commercial |
$8,297.04
|
| Rate for Payer: PACE Medicare |
$2,627.40
|
| Rate for Payer: PACE SWMI |
$2,765.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,765.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,943.95
|
| Rate for Payer: Priority Health Medicare |
$2,765.68
|
| Rate for Payer: Priority Health Tiered Network |
$7,155.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,765.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,765.68
|
| Rate for Payer: UHC Medicaid |
$1,446.45
|
| Rate for Payer: UHCCP Medicaid |
$1,446.45
|
| Rate for Payer: VA VA |
$2,765.68
|
|
|
SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SECOND STAGE
|
Facility
|
OP
|
$8,943.95
|
|
|
Service Code
|
CPT 46285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,275.55 |
| Max. Negotiated Rate |
$8,943.95 |
| Rate for Payer: Aetna Medicare |
$2,876.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,457.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,457.10
|
| Rate for Payer: BCBS Complete |
$1,518.91
|
| Rate for Payer: BCBS MAPPO |
$2,765.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,275.55
|
| Rate for Payer: BCN Commercial |
$1,275.55
|
| Rate for Payer: BCN Medicare Advantage |
$2,765.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,765.68
|
| Rate for Payer: Mclaren Medicaid |
$1,446.45
|
| Rate for Payer: Mclaren Medicare |
$2,765.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,903.96
|
| Rate for Payer: Meridian Medicaid |
$2,903.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,180.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,042.25
|
| Rate for Payer: Nomi Health Commercial |
$8,297.04
|
| Rate for Payer: PACE Medicare |
$2,627.40
|
| Rate for Payer: PACE SWMI |
$2,765.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,765.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,943.95
|
| Rate for Payer: Priority Health Medicare |
$2,765.68
|
| Rate for Payer: Priority Health Tiered Network |
$7,155.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,765.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,765.68
|
| Rate for Payer: UHC Medicaid |
$1,446.45
|
| Rate for Payer: UHCCP Medicaid |
$1,446.45
|
| Rate for Payer: VA VA |
$2,765.68
|
|
|
SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SUBCUTANEOUS
|
Facility
|
OP
|
$8,943.95
|
|
|
Service Code
|
CPT 46270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,446.45 |
| Max. Negotiated Rate |
$8,943.95 |
| Rate for Payer: Aetna Medicare |
$2,876.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,457.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,457.10
|
| Rate for Payer: BCBS Complete |
$1,518.91
|
| Rate for Payer: BCBS MAPPO |
$2,765.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,697.82
|
| Rate for Payer: BCN Commercial |
$1,697.82
|
| Rate for Payer: BCN Medicare Advantage |
$2,765.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,765.68
|
| Rate for Payer: Mclaren Medicaid |
$1,446.45
|
| Rate for Payer: Mclaren Medicare |
$2,765.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,903.96
|
| Rate for Payer: Meridian Medicaid |
$2,903.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,180.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,042.25
|
| Rate for Payer: Nomi Health Commercial |
$8,297.04
|
| Rate for Payer: PACE Medicare |
$2,627.40
|
| Rate for Payer: PACE SWMI |
$2,765.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,765.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,943.95
|
| Rate for Payer: Priority Health Medicare |
$2,765.68
|
| Rate for Payer: Priority Health Tiered Network |
$7,155.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,765.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,765.68
|
| Rate for Payer: UHC Medicaid |
$1,446.45
|
| Rate for Payer: UHCCP Medicaid |
$1,446.45
|
| Rate for Payer: VA VA |
$2,765.68
|
|
|
SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); TRANSSPHINCTERIC, SUPRASPHINCTERIC, EXTRASPHINCTERIC OR MULTIPLE, INCLUDING PLACEMENT OF SETON, WHEN PERFORMED
|
Facility
|
OP
|
$8,943.95
|
|
|
Service Code
|
CPT 46280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,446.45 |
| Max. Negotiated Rate |
$8,943.95 |
| Rate for Payer: Aetna Medicare |
$2,876.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,457.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,457.10
|
| Rate for Payer: BCBS Complete |
$1,518.91
|
| Rate for Payer: BCBS MAPPO |
$2,765.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,235.96
|
| Rate for Payer: BCN Commercial |
$2,235.96
|
| Rate for Payer: BCN Medicare Advantage |
$2,765.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,765.68
|
| Rate for Payer: Mclaren Medicaid |
$1,446.45
|
| Rate for Payer: Mclaren Medicare |
$2,765.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,903.96
|
| Rate for Payer: Meridian Medicaid |
$2,903.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,180.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,042.25
|
| Rate for Payer: Nomi Health Commercial |
$8,297.04
|
| Rate for Payer: PACE Medicare |
$2,627.40
|
| Rate for Payer: PACE SWMI |
$2,765.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,765.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,943.95
|
| Rate for Payer: Priority Health Medicare |
$2,765.68
|
| Rate for Payer: Priority Health Tiered Network |
$7,155.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,765.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,765.68
|
| Rate for Payer: UHC Medicaid |
$1,446.45
|
| Rate for Payer: UHCCP Medicaid |
$1,446.45
|
| Rate for Payer: VA VA |
$2,765.68
|
|
|
SURGICEL, OXIDIZED 2" X 1" MISC
|
Facility
|
IP
|
$299.92
|
|
|
Service Code
|
NDC 63713001961
|
| Hospital Charge Code |
200200150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$188.95 |
| Max. Negotiated Rate |
$269.93 |
| Rate for Payer: Aetna Commercial |
$254.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.95
|
| Rate for Payer: Cash Price |
$239.94
|
| Rate for Payer: Cofinity Advantage |
$209.94
|
| Rate for Payer: Cofinity Commercial |
$257.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.94
|
| Rate for Payer: Healthscope Commercial |
$269.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.94
|
| Rate for Payer: PHP Commercial |
$254.93
|
| Rate for Payer: Priority Health SBD |
$188.95
|
|
|
SURGICEL, OXIDIZED 2" X 1" MISC
|
Facility
|
OP
|
$299.92
|
|
|
Service Code
|
NDC 63713001961
|
| Hospital Charge Code |
200200150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$117.87 |
| Max. Negotiated Rate |
$269.93 |
| Rate for Payer: Aetna Commercial |
$254.93
|
| Rate for Payer: Aetna Medicare |
$149.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.95
|
| Rate for Payer: BCBS Complete |
$119.97
|
| Rate for Payer: Cash Price |
$239.94
|
| Rate for Payer: Cofinity Advantage |
$209.94
|
| Rate for Payer: Cofinity Commercial |
$257.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.94
|
| Rate for Payer: Healthscope Commercial |
$269.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$239.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.94
|
| Rate for Payer: PHP Commercial |
$254.93
|
| Rate for Payer: Priority Health SBD |
$188.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.95
|
| Rate for Payer: UHC Core |
$156.26
|
| Rate for Payer: UHC Exchange |
$117.87
|
|
|
SUTIMLIMAB-JOME 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,320.45
|
|
|
Service Code
|
HCPCS J1302
|
| Hospital Charge Code |
199304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$5,688.40 |
| Rate for Payer: Aetna Commercial |
$5,372.38
|
| Rate for Payer: Aetna Medicare |
$20.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,108.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.55
|
| Rate for Payer: BCBS Complete |
$10.79
|
| Rate for Payer: BCBS MAPPO |
$19.64
|
| Rate for Payer: BCBS Trust/PPO |
$47.72
|
| Rate for Payer: BCN Commercial |
$47.72
|
| Rate for Payer: BCN Medicare Advantage |
$19.64
|
| Rate for Payer: Cash Price |
$5,056.36
|
| Rate for Payer: Cash Price |
$5,056.36
|
| Rate for Payer: Cofinity Advantage |
$4,424.31
|
| Rate for Payer: Cofinity Commercial |
$5,435.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,056.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.64
|
| Rate for Payer: Healthscope Commercial |
$5,688.40
|
| Rate for Payer: Mclaren Medicaid |
$10.27
|
| Rate for Payer: Mclaren Medicare |
$19.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.62
|
| Rate for Payer: Meridian Medicaid |
$20.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,372.38
|
| Rate for Payer: Nomi Health Commercial |
$58.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,740.34
|
| Rate for Payer: PACE Medicare |
$18.66
|
| Rate for Payer: PACE SWMI |
$19.64
|
| Rate for Payer: PHP Commercial |
$5,372.38
|
| Rate for Payer: PHP Medicare Advantage |
$19.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$59.48
|
| Rate for Payer: Priority Health Medicare |
$19.64
|
| Rate for Payer: Priority Health SBD |
$3,981.88
|
| Rate for Payer: Priority Health Tiered Network |
$47.58
|
| Rate for Payer: Railroad Medicare Medicare |
$19.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.40
|
| Rate for Payer: UHC Core |
$31.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19.64
|
| Rate for Payer: UHC Exchange |
$31.40
|
| Rate for Payer: UHC Medicaid |
$10.27
|
| Rate for Payer: UHCCP Medicaid |
$10.27
|
| Rate for Payer: VA VA |
$19.64
|
|
|
SUTURE OF INFRAPATELLAR TENDON; PRIMARY
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 27380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,638.51 |
| 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 |
$3,638.51
|
| Rate for Payer: BCN Commercial |
$3,638.51
|
| 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
|
|
|
SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; PRIMARY
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 27385
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| 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 |
$3,919.94
|
| Rate for Payer: BCN Commercial |
$3,919.94
|
| 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
|
|
|
SUVOREXANT 10 MG TABLET
|
Facility
|
IP
|
$1,641.14
|
|
|
Service Code
|
NDC 00006003330
|
| Hospital Charge Code |
173275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,033.92 |
| Max. Negotiated Rate |
$1,477.03 |
| Rate for Payer: Aetna Commercial |
$1,394.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,066.74
|
| Rate for Payer: Cash Price |
$1,312.91
|
| Rate for Payer: Cofinity Advantage |
$1,148.80
|
| Rate for Payer: Cofinity Commercial |
$1,411.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,312.91
|
| Rate for Payer: Healthscope Commercial |
$1,477.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,394.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,230.86
|
| Rate for Payer: PHP Commercial |
$1,394.97
|
| Rate for Payer: Priority Health SBD |
$1,033.92
|
|
|
SUVOREXANT 10 MG TABLET
|
Facility
|
OP
|
$1,641.14
|
|
|
Service Code
|
NDC 00006003330
|
| Hospital Charge Code |
173275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$644.97 |
| Max. Negotiated Rate |
$1,477.03 |
| Rate for Payer: Aetna Commercial |
$1,394.97
|
| Rate for Payer: Aetna Medicare |
$820.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,066.74
|
| Rate for Payer: BCBS Complete |
$656.46
|
| Rate for Payer: Cash Price |
$1,312.91
|
| Rate for Payer: Cofinity Advantage |
$1,148.80
|
| Rate for Payer: Cofinity Commercial |
$1,411.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,312.91
|
| Rate for Payer: Healthscope Commercial |
$1,477.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,312.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,394.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,230.86
|
| Rate for Payer: PHP Commercial |
$1,394.97
|
| Rate for Payer: Priority Health SBD |
$1,033.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,066.74
|
| Rate for Payer: UHC Core |
$855.03
|
| Rate for Payer: UHC Exchange |
$644.97
|
|
|
SUVOREXANT 10 MG TABLET
|
Facility
|
IP
|
$547.05
|
|
|
Service Code
|
NDC 00006003310
|
| Hospital Charge Code |
173275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$344.64 |
| Max. Negotiated Rate |
$492.35 |
| Rate for Payer: Aetna Commercial |
$464.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.58
|
| Rate for Payer: Cash Price |
$437.64
|
| Rate for Payer: Cofinity Advantage |
$382.94
|
| Rate for Payer: Cofinity Commercial |
$470.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$437.64
|
| Rate for Payer: Healthscope Commercial |
$492.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.29
|
| Rate for Payer: PHP Commercial |
$464.99
|
| Rate for Payer: Priority Health SBD |
$344.64
|
|
|
SUVOREXANT 10 MG TABLET
|
Facility
|
OP
|
$547.05
|
|
|
Service Code
|
NDC 00006003310
|
| Hospital Charge Code |
173275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.99 |
| Max. Negotiated Rate |
$492.35 |
| Rate for Payer: Aetna Commercial |
$464.99
|
| Rate for Payer: Aetna Medicare |
$273.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.58
|
| Rate for Payer: BCBS Complete |
$218.82
|
| Rate for Payer: Cash Price |
$437.64
|
| Rate for Payer: Cofinity Advantage |
$382.94
|
| Rate for Payer: Cofinity Commercial |
$470.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$437.64
|
| Rate for Payer: Healthscope Commercial |
$492.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$437.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.29
|
| Rate for Payer: PHP Commercial |
$464.99
|
| Rate for Payer: Priority Health SBD |
$344.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.58
|
| Rate for Payer: UHC Core |
$285.01
|
| Rate for Payer: UHC Exchange |
$214.99
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$16,327.08
|
|
|
Service Code
|
MSDRG 312
|
| Min. Negotiated Rate |
$6,949.16 |
| Max. Negotiated Rate |
$16,327.08 |
| Rate for Payer: Aetna Medicare |
$7,607.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,143.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,143.64
|
| Rate for Payer: BCBS MAPPO |
$7,314.91
|
| Rate for Payer: BCBS Trust/PPO |
$16,327.08
|
| Rate for Payer: BCN Commercial |
$16,327.08
|
| Rate for Payer: BCN Medicare Advantage |
$7,314.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,314.91
|
| Rate for Payer: Mclaren Medicare |
$7,314.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,680.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,412.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,046.40
|
| Rate for Payer: Nomi Health Commercial |
$11,243.64
|
| Rate for Payer: PACE Medicare |
$6,949.16
|
| Rate for Payer: PACE SWMI |
$7,314.91
|
| Rate for Payer: PHP Medicare Advantage |
$7,314.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,052.06
|
| Rate for Payer: Priority Health Medicare |
$7,314.91
|
| Rate for Payer: Priority Health Tiered Network |
$11,241.64
|
| Rate for Payer: Railroad Medicare Medicare |
$7,314.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,207.08
|
| Rate for Payer: UHC Core |
$11,886.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,314.91
|
| Rate for Payer: UHC Exchange |
$9,707.01
|
| Rate for Payer: VA VA |
$7,314.91
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$10,150.28
|
|
|
Service Code
|
APR-DRG 2044
|
| Min. Negotiated Rate |
$9,666.93 |
| Max. Negotiated Rate |
$10,150.28 |
| Rate for Payer: BCBS Complete |
$10,150.28
|
| Rate for Payer: Mclaren Medicaid |
$9,666.93
|
| Rate for Payer: Meridian Medicaid |
$10,150.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,666.93
|
| Rate for Payer: UHC Medicaid |
$9,666.93
|
| Rate for Payer: UHCCP Medicaid |
$9,666.93
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$4,111.71
|
|
|
Service Code
|
APR-DRG 2041
|
| Min. Negotiated Rate |
$3,915.91 |
| Max. Negotiated Rate |
$4,111.71 |
| Rate for Payer: BCBS Complete |
$4,111.71
|
| Rate for Payer: Mclaren Medicaid |
$3,915.91
|
| Rate for Payer: Meridian Medicaid |
$4,111.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,915.91
|
| Rate for Payer: UHC Medicaid |
$3,915.91
|
| Rate for Payer: UHCCP Medicaid |
$3,915.91
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$5,020.39
|
|
|
Service Code
|
APR-DRG 2042
|
| Min. Negotiated Rate |
$4,781.32 |
| Max. Negotiated Rate |
$5,020.39 |
| Rate for Payer: BCBS Complete |
$5,020.39
|
| Rate for Payer: Mclaren Medicaid |
$4,781.32
|
| Rate for Payer: Meridian Medicaid |
$5,020.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,781.32
|
| Rate for Payer: UHC Medicaid |
$4,781.32
|
| Rate for Payer: UHCCP Medicaid |
$4,781.32
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$6,141.19
|
|
|
Service Code
|
APR-DRG 2043
|
| Min. Negotiated Rate |
$5,848.75 |
| Max. Negotiated Rate |
$6,141.19 |
| Rate for Payer: BCBS Complete |
$6,141.19
|
| Rate for Payer: Mclaren Medicaid |
$5,848.75
|
| Rate for Payer: Meridian Medicaid |
$6,141.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,848.75
|
| Rate for Payer: UHC Medicaid |
$5,848.75
|
| Rate for Payer: UHCCP Medicaid |
$5,848.75
|
|
|
TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
OP
|
$4.74
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
24914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$4.03
|
| Rate for Payer: Aetna Commercial |
$345.58
|
| Rate for Payer: Aetna Commercial |
$311.61
|
| Rate for Payer: Aetna Commercial |
$402.29
|
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna Medicare |
$136.80
|
| Rate for Payer: Aetna Medicare |
$183.30
|
| Rate for Payer: Aetna Medicare |
$203.28
|
| Rate for Payer: Aetna Medicare |
$2.37
|
| Rate for Payer: Aetna Medicare |
$236.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Complete |
$146.64
|
| Rate for Payer: BCBS Complete |
$162.62
|
| Rate for Payer: BCBS Complete |
$109.44
|
| Rate for Payer: BCBS Complete |
$189.31
|
| Rate for Payer: BCBS Trust/PPO |
$0.49
|
| Rate for Payer: BCBS Trust/PPO |
$0.49
|
| Rate for Payer: BCBS Trust/PPO |
$0.49
|
| Rate for Payer: BCBS Trust/PPO |
$0.49
|
| Rate for Payer: BCBS Trust/PPO |
$0.49
|
| Rate for Payer: BCN Commercial |
$0.49
|
| Rate for Payer: BCN Commercial |
$0.49
|
| Rate for Payer: BCN Commercial |
$0.49
|
| Rate for Payer: BCN Commercial |
$0.49
|
| Rate for Payer: BCN Commercial |
$0.49
|
| Rate for Payer: Cash Price |
$378.62
|
| Rate for Payer: Cash Price |
$293.28
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cash Price |
$325.25
|
| Rate for Payer: Cash Price |
$293.28
|
| Rate for Payer: Cash Price |
$325.25
|
| Rate for Payer: Cash Price |
$378.62
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: Cofinity Advantage |
$3.32
|
| Rate for Payer: Cofinity Advantage |
$331.30
|
| Rate for Payer: Cofinity Advantage |
$256.62
|
| Rate for Payer: Cofinity Advantage |
$191.52
|
| Rate for Payer: Cofinity Advantage |
$284.59
|
| Rate for Payer: Cofinity Commercial |
$349.64
|
| Rate for Payer: Cofinity Commercial |
$315.28
|
| Rate for Payer: Cofinity Commercial |
$407.02
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.28
|
| Rate for Payer: Healthscope Commercial |
$329.94
|
| Rate for Payer: Healthscope Commercial |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$425.95
|
| Rate for Payer: Healthscope Commercial |
$365.90
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$325.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.96
|
| Rate for Payer: PHP Commercial |
$345.58
|
| Rate for Payer: PHP Commercial |
$311.61
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: PHP Commercial |
$4.03
|
| Rate for Payer: PHP Commercial |
$402.29
|
| Rate for Payer: Priority Health SBD |
$256.13
|
| Rate for Payer: Priority Health SBD |
$298.17
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: Priority Health SBD |
$230.96
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Core |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.33
|
|
