|
URSODIOL 300 MG CAPSULE
|
Facility
|
OP
|
$558.24
|
|
|
Service Code
|
NDC 00527132601
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.39 |
| Max. Negotiated Rate |
$502.42 |
| Rate for Payer: Aetna Commercial |
$474.50
|
| Rate for Payer: Aetna Medicare |
$279.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.86
|
| Rate for Payer: BCBS Complete |
$223.30
|
| Rate for Payer: Cash Price |
$446.59
|
| Rate for Payer: Cofinity Advantage |
$390.77
|
| Rate for Payer: Cofinity Commercial |
$480.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$446.59
|
| Rate for Payer: Healthscope Commercial |
$502.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$446.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$474.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$418.68
|
| Rate for Payer: PHP Commercial |
$474.50
|
| Rate for Payer: Priority Health SBD |
$351.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$362.86
|
| Rate for Payer: UHC Core |
$290.84
|
| Rate for Payer: UHC Exchange |
$219.39
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
IP
|
$470.64
|
|
|
Service Code
|
NDC 50268079715
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$296.50 |
| Max. Negotiated Rate |
$423.58 |
| Rate for Payer: Aetna Commercial |
$400.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.92
|
| Rate for Payer: Cash Price |
$376.51
|
| Rate for Payer: Cofinity Advantage |
$329.45
|
| Rate for Payer: Cofinity Commercial |
$404.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.51
|
| Rate for Payer: Healthscope Commercial |
$423.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.98
|
| Rate for Payer: PHP Commercial |
$400.04
|
| Rate for Payer: Priority Health SBD |
$296.50
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
IP
|
$558.24
|
|
|
Service Code
|
NDC 00527132601
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$351.69 |
| Max. Negotiated Rate |
$502.42 |
| Rate for Payer: Aetna Commercial |
$474.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.86
|
| Rate for Payer: Cash Price |
$446.59
|
| Rate for Payer: Cofinity Advantage |
$390.77
|
| Rate for Payer: Cofinity Commercial |
$480.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$446.59
|
| Rate for Payer: Healthscope Commercial |
$502.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$474.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$418.68
|
| Rate for Payer: PHP Commercial |
$474.50
|
| Rate for Payer: Priority Health SBD |
$351.69
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
OP
|
$402.80
|
|
|
Service Code
|
NDC 42806050301
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.30 |
| Max. Negotiated Rate |
$362.52 |
| Rate for Payer: Aetna Commercial |
$342.38
|
| Rate for Payer: Aetna Medicare |
$201.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.82
|
| Rate for Payer: BCBS Complete |
$161.12
|
| Rate for Payer: Cash Price |
$322.24
|
| Rate for Payer: Cofinity Advantage |
$281.96
|
| Rate for Payer: Cofinity Commercial |
$346.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.24
|
| Rate for Payer: Healthscope Commercial |
$362.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$322.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$302.10
|
| Rate for Payer: PHP Commercial |
$342.38
|
| Rate for Payer: Priority Health SBD |
$253.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.82
|
| Rate for Payer: UHC Core |
$209.86
|
| Rate for Payer: UHC Exchange |
$158.30
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
OP
|
$427.92
|
|
|
Service Code
|
NDC 00904622106
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.17 |
| Max. Negotiated Rate |
$385.13 |
| Rate for Payer: Aetna Commercial |
$363.73
|
| Rate for Payer: Aetna Medicare |
$213.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.15
|
| Rate for Payer: BCBS Complete |
$171.17
|
| Rate for Payer: Cash Price |
$342.34
|
| Rate for Payer: Cofinity Advantage |
$299.54
|
| Rate for Payer: Cofinity Commercial |
$368.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.34
|
| Rate for Payer: Healthscope Commercial |
$385.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$342.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.94
|
| Rate for Payer: PHP Commercial |
$363.73
|
| Rate for Payer: Priority Health SBD |
$269.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.15
|
| Rate for Payer: UHC Core |
$222.95
|
| Rate for Payer: UHC Exchange |
$168.17
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
IP
|
$9.42
|
|
|
Service Code
|
NDC 50268079711
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$8.48 |
| Rate for Payer: Aetna Commercial |
$8.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.12
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cofinity Advantage |
$6.59
|
| Rate for Payer: Cofinity Commercial |
$8.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.54
|
| Rate for Payer: Healthscope Commercial |
$8.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.07
|
| Rate for Payer: PHP Commercial |
$8.01
|
| Rate for Payer: Priority Health SBD |
$5.93
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
OP
|
$9.42
|
|
|
Service Code
|
NDC 50268079711
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$8.48 |
| Rate for Payer: Aetna Commercial |
$8.01
|
| Rate for Payer: Aetna Medicare |
$4.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.12
|
| Rate for Payer: BCBS Complete |
$3.77
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cofinity Advantage |
$6.59
|
| Rate for Payer: Cofinity Commercial |
$8.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.54
|
| Rate for Payer: Healthscope Commercial |
$8.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.07
|
| Rate for Payer: PHP Commercial |
$8.01
|
| Rate for Payer: Priority Health SBD |
$5.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.12
|
| Rate for Payer: UHC Core |
$4.91
|
| Rate for Payer: UHC Exchange |
$3.70
|
|
|
USTEKINUMAB 130 MG/26 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,508.39
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
180872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,470.29 |
| Max. Negotiated Rate |
$4,957.55 |
| Rate for Payer: Aetna Commercial |
$4,682.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,580.45
|
| Rate for Payer: Cash Price |
$4,406.71
|
| Rate for Payer: Cofinity Advantage |
$3,855.87
|
| Rate for Payer: Cofinity Commercial |
$4,737.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,406.71
|
| Rate for Payer: Healthscope Commercial |
$4,957.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,682.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,131.29
|
| Rate for Payer: PHP Commercial |
$4,682.13
|
| Rate for Payer: Priority Health SBD |
$3,470.29
|
|
|
USTEKINUMAB 130 MG/26 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,508.39
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
180872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.08 |
| Max. Negotiated Rate |
$4,957.55 |
| Rate for Payer: Aetna Commercial |
$4,682.13
|
| Rate for Payer: Aetna Medicare |
$12.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,580.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.53
|
| Rate for Payer: BCBS Complete |
$6.38
|
| Rate for Payer: BCBS MAPPO |
$11.62
|
| Rate for Payer: BCBS Trust/PPO |
$31.32
|
| Rate for Payer: BCN Commercial |
$31.32
|
| Rate for Payer: BCN Medicare Advantage |
$11.62
|
| Rate for Payer: Cash Price |
$4,406.71
|
| Rate for Payer: Cash Price |
$4,406.71
|
| Rate for Payer: Cofinity Advantage |
$3,855.87
|
| Rate for Payer: Cofinity Commercial |
$4,737.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,406.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.62
|
| Rate for Payer: Healthscope Commercial |
$4,957.55
|
| Rate for Payer: Mclaren Medicaid |
$6.08
|
| Rate for Payer: Mclaren Medicare |
$11.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.20
|
| Rate for Payer: Meridian Medicaid |
$12.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,682.13
|
| Rate for Payer: Nomi Health Commercial |
$34.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,131.29
|
| Rate for Payer: PACE Medicare |
$11.04
|
| Rate for Payer: PACE SWMI |
$11.62
|
| Rate for Payer: PHP Commercial |
$4,682.13
|
| Rate for Payer: PHP Medicare Advantage |
$11.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$40.97
|
| Rate for Payer: Priority Health Medicare |
$11.62
|
| Rate for Payer: Priority Health SBD |
$3,470.29
|
| Rate for Payer: Priority Health Tiered Network |
$32.78
|
| Rate for Payer: Railroad Medicare Medicare |
$11.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.61
|
| Rate for Payer: UHC Core |
$20.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.62
|
| Rate for Payer: UHC Exchange |
$20.61
|
| Rate for Payer: UHC Medicaid |
$6.08
|
| Rate for Payer: UHCCP Medicaid |
$6.08
|
| Rate for Payer: VA VA |
$11.62
|
|
|
USTEKINUMAB 45 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$38,797.00
|
|
|
Service Code
|
HCPCS J3357
|
| Hospital Charge Code |
119468
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24,442.11 |
| Max. Negotiated Rate |
$34,917.30 |
| Rate for Payer: Aetna Commercial |
$32,977.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25,218.05
|
| Rate for Payer: Cash Price |
$31,037.60
|
| Rate for Payer: Cofinity Advantage |
$27,157.90
|
| Rate for Payer: Cofinity Commercial |
$33,365.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31,037.60
|
| Rate for Payer: Healthscope Commercial |
$34,917.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32,977.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29,097.75
|
| Rate for Payer: PHP Commercial |
$32,977.45
|
| Rate for Payer: Priority Health SBD |
$24,442.11
|
|
|
USTEKINUMAB 45 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$38,797.00
|
|
|
Service Code
|
HCPCS J3357
|
| Hospital Charge Code |
119468
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$240.34 |
| Max. Negotiated Rate |
$34,917.30 |
| Rate for Payer: Aetna Commercial |
$32,977.45
|
| Rate for Payer: Aetna Medicare |
$19,398.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25,218.05
|
| Rate for Payer: BCBS Complete |
$15,518.80
|
| Rate for Payer: Cash Price |
$31,037.60
|
| Rate for Payer: Cash Price |
$31,037.60
|
| Rate for Payer: Cofinity Advantage |
$27,157.90
|
| Rate for Payer: Cofinity Commercial |
$33,365.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31,037.60
|
| Rate for Payer: Healthscope Commercial |
$34,917.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,037.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32,977.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29,097.75
|
| Rate for Payer: PHP Commercial |
$32,977.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$300.43
|
| Rate for Payer: Priority Health SBD |
$24,442.11
|
| Rate for Payer: Priority Health Tiered Network |
$240.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$672.72
|
| Rate for Payer: UHC Core |
$672.72
|
| Rate for Payer: UHC Exchange |
$672.72
|
|
|
USTEKINUMAB 90 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$77,593.88
|
|
|
Service Code
|
HCPCS J3357
|
| Hospital Charge Code |
119469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$240.34 |
| Max. Negotiated Rate |
$69,834.49 |
| Rate for Payer: Aetna Commercial |
$65,954.80
|
| Rate for Payer: Aetna Medicare |
$38,796.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50,436.02
|
| Rate for Payer: BCBS Complete |
$31,037.55
|
| Rate for Payer: Cash Price |
$62,075.10
|
| Rate for Payer: Cash Price |
$62,075.10
|
| Rate for Payer: Cofinity Advantage |
$54,315.72
|
| Rate for Payer: Cofinity Commercial |
$66,730.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62,075.10
|
| Rate for Payer: Healthscope Commercial |
$69,834.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62,075.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65,954.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58,195.41
|
| Rate for Payer: PHP Commercial |
$65,954.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$300.43
|
| Rate for Payer: Priority Health SBD |
$48,884.14
|
| Rate for Payer: Priority Health Tiered Network |
$240.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$672.72
|
| Rate for Payer: UHC Core |
$672.72
|
| Rate for Payer: UHC Exchange |
$672.72
|
|
|
USTEKINUMAB 90 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$77,593.88
|
|
|
Service Code
|
HCPCS J3357
|
| Hospital Charge Code |
119469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48,884.14 |
| Max. Negotiated Rate |
$69,834.49 |
| Rate for Payer: Aetna Commercial |
$65,954.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50,436.02
|
| Rate for Payer: Cash Price |
$62,075.10
|
| Rate for Payer: Cofinity Advantage |
$54,315.72
|
| Rate for Payer: Cofinity Commercial |
$66,730.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62,075.10
|
| Rate for Payer: Healthscope Commercial |
$69,834.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65,954.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58,195.41
|
| Rate for Payer: PHP Commercial |
$65,954.80
|
| Rate for Payer: Priority Health SBD |
$48,884.14
|
|
|
USTEKINUMAB-KFCE 130 MG/26 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,247.92
|
|
|
Service Code
|
HCPCS Q5100
|
| Hospital Charge Code |
209995
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$786.19 |
| Max. Negotiated Rate |
$1,123.13 |
| Rate for Payer: Aetna Commercial |
$1,060.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$811.15
|
| Rate for Payer: Cash Price |
$998.34
|
| Rate for Payer: Cofinity Advantage |
$873.54
|
| Rate for Payer: Cofinity Commercial |
$1,073.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$998.34
|
| Rate for Payer: Healthscope Commercial |
$1,123.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,060.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$935.94
|
| Rate for Payer: PHP Commercial |
$1,060.73
|
| Rate for Payer: Priority Health SBD |
$786.19
|
|
|
USTEKINUMAB-KFCE 130 MG/26 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,247.92
|
|
|
Service Code
|
HCPCS Q5100
|
| Hospital Charge Code |
209995
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$1,123.13 |
| Rate for Payer: Aetna Commercial |
$1,060.73
|
| Rate for Payer: Aetna Medicare |
$3.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$811.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.19
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: BCBS MAPPO |
$3.35
|
| Rate for Payer: BCBS Trust/PPO |
$63.14
|
| Rate for Payer: BCN Commercial |
$63.14
|
| Rate for Payer: BCN Medicare Advantage |
$3.35
|
| Rate for Payer: Cash Price |
$998.34
|
| Rate for Payer: Cash Price |
$998.34
|
| Rate for Payer: Cofinity Advantage |
$873.54
|
| Rate for Payer: Cofinity Commercial |
$1,073.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$998.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.35
|
| Rate for Payer: Healthscope Commercial |
$1,123.13
|
| Rate for Payer: Mclaren Medicaid |
$1.75
|
| Rate for Payer: Mclaren Medicare |
$3.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.52
|
| Rate for Payer: Meridian Medicaid |
$3.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,060.73
|
| Rate for Payer: Nomi Health Commercial |
$10.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$935.94
|
| Rate for Payer: PACE Medicare |
$3.18
|
| Rate for Payer: PACE SWMI |
$3.35
|
| Rate for Payer: PHP Commercial |
$1,060.73
|
| Rate for Payer: PHP Medicare Advantage |
$3.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$78.77
|
| Rate for Payer: Priority Health Medicare |
$3.35
|
| Rate for Payer: Priority Health SBD |
$786.19
|
| Rate for Payer: Priority Health Tiered Network |
$63.02
|
| Rate for Payer: Railroad Medicare Medicare |
$3.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.72
|
| Rate for Payer: UHC Core |
$40.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.35
|
| Rate for Payer: UHC Exchange |
$40.72
|
| Rate for Payer: UHC Medicaid |
$1.75
|
| Rate for Payer: UHCCP Medicaid |
$1.75
|
| Rate for Payer: VA VA |
$3.35
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$30,404.65
|
|
|
Service Code
|
MSDRG 742
|
| Min. Negotiated Rate |
$14,020.82 |
| Max. Negotiated Rate |
$30,404.65 |
| Rate for Payer: Aetna Medicare |
$15,349.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,448.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,448.45
|
| Rate for Payer: BCBS MAPPO |
$14,758.76
|
| Rate for Payer: BCBS Trust/PPO |
$30,404.65
|
| Rate for Payer: BCN Commercial |
$30,404.65
|
| Rate for Payer: BCN Medicare Advantage |
$14,758.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,758.76
|
| Rate for Payer: Mclaren Medicare |
$14,758.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,496.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,972.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,234.64
|
| Rate for Payer: Nomi Health Commercial |
$23,668.92
|
| Rate for Payer: PACE Medicare |
$14,020.82
|
| Rate for Payer: PACE SWMI |
$14,758.76
|
| Rate for Payer: PHP Medicare Advantage |
$14,758.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29,580.90
|
| Rate for Payer: Priority Health Medicare |
$14,758.76
|
| Rate for Payer: Priority Health Tiered Network |
$23,664.72
|
| Rate for Payer: Railroad Medicare Medicare |
$14,758.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,907.24
|
| Rate for Payer: UHC Core |
$25,021.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,758.76
|
| Rate for Payer: UHC Exchange |
$20,434.17
|
| Rate for Payer: VA VA |
$14,758.76
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$22,031.61
|
|
|
Service Code
|
MSDRG 743
|
| Min. Negotiated Rate |
$9,659.06 |
| Max. Negotiated Rate |
$22,031.61 |
| Rate for Payer: Aetna Medicare |
$10,574.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,709.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,709.29
|
| Rate for Payer: BCBS MAPPO |
$10,167.43
|
| Rate for Payer: BCBS Trust/PPO |
$22,031.61
|
| Rate for Payer: BCN Commercial |
$22,031.61
|
| Rate for Payer: BCN Medicare Advantage |
$10,167.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,167.43
|
| Rate for Payer: Mclaren Medicare |
$10,167.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,675.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,692.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,184.17
|
| Rate for Payer: Nomi Health Commercial |
$16,005.03
|
| Rate for Payer: PACE Medicare |
$9,659.06
|
| Rate for Payer: PACE SWMI |
$10,167.43
|
| Rate for Payer: PHP Medicare Advantage |
$10,167.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,002.74
|
| Rate for Payer: Priority Health Medicare |
$10,167.43
|
| Rate for Payer: Priority Health Tiered Network |
$16,002.19
|
| Rate for Payer: Railroad Medicare Medicare |
$10,167.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,223.41
|
| Rate for Payer: UHC Core |
$16,919.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,167.43
|
| Rate for Payer: UHC Exchange |
$13,817.68
|
| Rate for Payer: VA VA |
$10,167.43
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC
|
Facility
|
IP
|
$37,209.36
|
|
|
Service Code
|
MSDRG 740
|
| Min. Negotiated Rate |
$13,835.80 |
| Max. Negotiated Rate |
$37,209.36 |
| Rate for Payer: Aetna Medicare |
$15,146.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,205.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,205.00
|
| Rate for Payer: BCBS MAPPO |
$14,564.00
|
| Rate for Payer: BCBS Trust/PPO |
$37,209.36
|
| Rate for Payer: BCN Commercial |
$37,209.36
|
| Rate for Payer: BCN Medicare Advantage |
$14,564.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,564.00
|
| Rate for Payer: Mclaren Medicare |
$14,564.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,292.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,748.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,020.40
|
| Rate for Payer: Nomi Health Commercial |
$23,343.84
|
| Rate for Payer: PACE Medicare |
$13,835.80
|
| Rate for Payer: PACE SWMI |
$14,564.00
|
| Rate for Payer: PHP Medicare Advantage |
$14,564.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29,174.62
|
| Rate for Payer: Priority Health Medicare |
$14,564.00
|
| Rate for Payer: Priority Health Tiered Network |
$23,339.70
|
| Rate for Payer: Railroad Medicare Medicare |
$14,564.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,496.48
|
| Rate for Payer: UHC Core |
$24,677.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,564.00
|
| Rate for Payer: UHC Exchange |
$20,153.52
|
| Rate for Payer: VA VA |
$14,564.00
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC
|
Facility
|
IP
|
$58,868.78
|
|
|
Service Code
|
MSDRG 739
|
| Min. Negotiated Rate |
$26,854.31 |
| Max. Negotiated Rate |
$58,868.78 |
| Rate for Payer: Aetna Medicare |
$29,398.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,334.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,334.61
|
| Rate for Payer: BCBS MAPPO |
$28,267.69
|
| Rate for Payer: BCBS Trust/PPO |
$58,868.78
|
| Rate for Payer: BCN Commercial |
$58,868.78
|
| Rate for Payer: BCN Medicare Advantage |
$28,267.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,267.69
|
| Rate for Payer: Mclaren Medicare |
$28,267.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,681.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,507.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$31,094.46
|
| Rate for Payer: Nomi Health Commercial |
$45,489.27
|
| Rate for Payer: PACE Medicare |
$26,854.31
|
| Rate for Payer: PACE SWMI |
$28,267.69
|
| Rate for Payer: PHP Medicare Advantage |
$28,267.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$57,762.40
|
| Rate for Payer: Priority Health Medicare |
$28,267.69
|
| Rate for Payer: Priority Health Tiered Network |
$46,209.92
|
| Rate for Payer: Railroad Medicare Medicare |
$28,267.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57,478.69
|
| Rate for Payer: UHC Core |
$48,088.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28,267.69
|
| Rate for Payer: UHC Exchange |
$39,272.40
|
| Rate for Payer: VA VA |
$28,267.69
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$27,731.46
|
|
|
Service Code
|
MSDRG 741
|
| Min. Negotiated Rate |
$11,020.23 |
| Max. Negotiated Rate |
$27,731.46 |
| Rate for Payer: Aetna Medicare |
$12,064.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,500.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,500.30
|
| Rate for Payer: BCBS MAPPO |
$11,600.24
|
| Rate for Payer: BCBS Trust/PPO |
$27,731.46
|
| Rate for Payer: BCN Commercial |
$27,731.46
|
| Rate for Payer: BCN Medicare Advantage |
$11,600.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,600.24
|
| Rate for Payer: Mclaren Medicare |
$11,600.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,180.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,340.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,760.26
|
| Rate for Payer: Nomi Health Commercial |
$18,396.69
|
| Rate for Payer: PACE Medicare |
$11,020.23
|
| Rate for Payer: PACE SWMI |
$11,600.24
|
| Rate for Payer: PHP Medicare Advantage |
$11,600.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,991.78
|
| Rate for Payer: Priority Health Medicare |
$11,600.24
|
| Rate for Payer: Priority Health Tiered Network |
$18,393.42
|
| Rate for Payer: Railroad Medicare Medicare |
$11,600.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,245.43
|
| Rate for Payer: UHC Core |
$19,447.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,600.24
|
| Rate for Payer: UHC Exchange |
$15,882.48
|
| Rate for Payer: VA VA |
$11,600.24
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC
|
Facility
|
IP
|
$37,050.18
|
|
|
Service Code
|
MSDRG 737
|
| Min. Negotiated Rate |
$15,678.60 |
| Max. Negotiated Rate |
$37,050.18 |
| Rate for Payer: Aetna Medicare |
$17,163.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,629.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,629.74
|
| Rate for Payer: BCBS MAPPO |
$16,503.79
|
| Rate for Payer: BCBS Trust/PPO |
$37,050.18
|
| Rate for Payer: BCN Commercial |
$37,050.18
|
| Rate for Payer: BCN Medicare Advantage |
$16,503.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,503.79
|
| Rate for Payer: Mclaren Medicare |
$16,503.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,328.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,979.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,154.17
|
| Rate for Payer: Nomi Health Commercial |
$26,581.74
|
| Rate for Payer: PACE Medicare |
$15,678.60
|
| Rate for Payer: PACE SWMI |
$16,503.79
|
| Rate for Payer: PHP Medicare Advantage |
$16,503.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,221.28
|
| Rate for Payer: Priority Health Medicare |
$16,503.79
|
| Rate for Payer: Priority Health Tiered Network |
$26,577.02
|
| Rate for Payer: Railroad Medicare Medicare |
$16,503.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,587.78
|
| Rate for Payer: UHC Core |
$28,100.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,503.79
|
| Rate for Payer: UHC Exchange |
$22,948.90
|
| Rate for Payer: VA VA |
$16,503.79
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC
|
Facility
|
IP
|
$70,350.40
|
|
|
Service Code
|
MSDRG 736
|
| Min. Negotiated Rate |
$26,793.37 |
| Max. Negotiated Rate |
$70,350.40 |
| Rate for Payer: Aetna Medicare |
$29,331.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,254.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,254.44
|
| Rate for Payer: BCBS MAPPO |
$28,203.55
|
| Rate for Payer: BCBS Trust/PPO |
$70,350.40
|
| Rate for Payer: BCN Commercial |
$70,350.40
|
| Rate for Payer: BCN Medicare Advantage |
$28,203.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,203.55
|
| Rate for Payer: Mclaren Medicare |
$28,203.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,613.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,434.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$31,023.90
|
| Rate for Payer: Nomi Health Commercial |
$46,111.05
|
| Rate for Payer: PACE Medicare |
$26,793.37
|
| Rate for Payer: PACE SWMI |
$28,203.55
|
| Rate for Payer: PHP Medicare Advantage |
$28,203.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$57,628.59
|
| Rate for Payer: Priority Health Medicare |
$28,203.55
|
| Rate for Payer: Priority Health Tiered Network |
$46,102.86
|
| Rate for Payer: Railroad Medicare Medicare |
$28,203.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58,264.35
|
| Rate for Payer: UHC Core |
$48,745.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28,203.55
|
| Rate for Payer: UHC Exchange |
$39,809.21
|
| Rate for Payer: VA VA |
$28,203.55
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$26,753.00
|
|
|
Service Code
|
MSDRG 738
|
| Min. Negotiated Rate |
$11,331.50 |
| Max. Negotiated Rate |
$26,753.00 |
| Rate for Payer: Aetna Medicare |
$12,405.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,909.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,909.88
|
| Rate for Payer: BCBS MAPPO |
$11,927.90
|
| Rate for Payer: BCBS Trust/PPO |
$26,753.00
|
| Rate for Payer: BCN Commercial |
$26,753.00
|
| Rate for Payer: BCN Medicare Advantage |
$11,927.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,927.90
|
| Rate for Payer: Mclaren Medicare |
$11,927.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,524.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,717.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,120.69
|
| Rate for Payer: Nomi Health Commercial |
$18,943.65
|
| Rate for Payer: PACE Medicare |
$11,331.50
|
| Rate for Payer: PACE SWMI |
$11,927.90
|
| Rate for Payer: PHP Medicare Advantage |
$11,927.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,675.36
|
| Rate for Payer: Priority Health Medicare |
$11,927.90
|
| Rate for Payer: Priority Health Tiered Network |
$18,940.29
|
| Rate for Payer: Railroad Medicare Medicare |
$11,927.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,936.55
|
| Rate for Payer: UHC Core |
$20,025.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,927.90
|
| Rate for Payer: UHC Exchange |
$16,354.68
|
| Rate for Payer: VA VA |
$11,927.90
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$28,314.73
|
|
|
Service Code
|
MSDRG 746
|
| Min. Negotiated Rate |
$13,303.52 |
| Max. Negotiated Rate |
$28,314.73 |
| Rate for Payer: Aetna Medicare |
$14,563.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,504.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,504.64
|
| Rate for Payer: BCBS MAPPO |
$14,003.71
|
| Rate for Payer: BCBS Trust/PPO |
$27,904.68
|
| Rate for Payer: BCN Commercial |
$27,904.68
|
| Rate for Payer: BCN Medicare Advantage |
$14,003.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,003.71
|
| Rate for Payer: Mclaren Medicare |
$14,003.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,703.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,104.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,404.08
|
| Rate for Payer: Nomi Health Commercial |
$22,408.59
|
| Rate for Payer: PACE Medicare |
$13,303.52
|
| Rate for Payer: PACE SWMI |
$14,003.71
|
| Rate for Payer: PHP Medicare Advantage |
$14,003.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28,005.77
|
| Rate for Payer: Priority Health Medicare |
$14,003.71
|
| Rate for Payer: Priority Health Tiered Network |
$22,404.61
|
| Rate for Payer: Railroad Medicare Medicare |
$14,003.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,314.73
|
| Rate for Payer: UHC Core |
$23,688.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,003.71
|
| Rate for Payer: UHC Exchange |
$19,346.08
|
| Rate for Payer: VA VA |
$14,003.71
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$23,127.10
|
|
|
Service Code
|
MSDRG 747
|
| Min. Negotiated Rate |
$6,861.80 |
| Max. Negotiated Rate |
$23,127.10 |
| Rate for Payer: Aetna Medicare |
$7,511.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,028.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,028.69
|
| Rate for Payer: BCBS MAPPO |
$7,222.95
|
| Rate for Payer: BCBS Trust/PPO |
$23,127.10
|
| Rate for Payer: BCN Commercial |
$23,127.10
|
| Rate for Payer: BCN Medicare Advantage |
$7,222.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,222.95
|
| Rate for Payer: Mclaren Medicare |
$7,222.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,584.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,306.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,945.24
|
| Rate for Payer: Nomi Health Commercial |
$10,829.55
|
| Rate for Payer: PACE Medicare |
$6,861.80
|
| Rate for Payer: PACE SWMI |
$7,222.95
|
| Rate for Payer: PHP Medicare Advantage |
$7,222.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,860.20
|
| Rate for Payer: Priority Health Medicare |
$7,222.95
|
| Rate for Payer: Priority Health Tiered Network |
$11,088.16
|
| Rate for Payer: Railroad Medicare Medicare |
$7,222.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,683.85
|
| Rate for Payer: UHC Core |
$11,448.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,222.95
|
| Rate for Payer: UHC Exchange |
$9,349.51
|
| Rate for Payer: VA VA |
$7,222.95
|
|
