|
DEFEROXAMINE 500 MG IM INJECTION
|
Facility
|
OP
|
$150.65
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
200070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$135.59 |
| Rate for Payer: Aetna Commercial |
$128.05
|
| Rate for Payer: Aetna Medicare |
$75.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.92
|
| Rate for Payer: BCBS Complete |
$60.26
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$21.23
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cofinity Advantage |
$105.45
|
| Rate for Payer: Cofinity Commercial |
$129.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Healthscope Commercial |
$135.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.99
|
| Rate for Payer: PHP Commercial |
$128.05
|
| Rate for Payer: Priority Health SBD |
$94.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.98
|
| Rate for Payer: UHC Core |
$13.98
|
| Rate for Payer: UHC Exchange |
$13.98
|
|
|
DEFEROXAMINE 500 MG IM INJECTION
|
Facility
|
IP
|
$150.65
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
200070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.91 |
| Max. Negotiated Rate |
$135.59 |
| Rate for Payer: Aetna Commercial |
$128.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.92
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cofinity Advantage |
$105.45
|
| Rate for Payer: Cofinity Commercial |
$129.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Healthscope Commercial |
$135.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.99
|
| Rate for Payer: PHP Commercial |
$128.05
|
| Rate for Payer: Priority Health SBD |
$94.91
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$42.72
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$38.45 |
| Rate for Payer: Aetna Commercial |
$36.31
|
| Rate for Payer: Aetna Commercial |
$51.90
|
| Rate for Payer: Aetna Commercial |
$128.05
|
| Rate for Payer: Aetna Commercial |
$31.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.92
|
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Cash Price |
$48.85
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cofinity Advantage |
$29.90
|
| Rate for Payer: Cofinity Advantage |
$105.45
|
| Rate for Payer: Cofinity Advantage |
$42.74
|
| Rate for Payer: Cofinity Advantage |
$25.89
|
| Rate for Payer: Cofinity Commercial |
$52.51
|
| Rate for Payer: Cofinity Commercial |
$36.74
|
| Rate for Payer: Cofinity Commercial |
$31.80
|
| Rate for Payer: Cofinity Commercial |
$129.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.18
|
| Rate for Payer: Healthscope Commercial |
$38.45
|
| Rate for Payer: Healthscope Commercial |
$54.95
|
| Rate for Payer: Healthscope Commercial |
$135.59
|
| Rate for Payer: Healthscope Commercial |
$33.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.73
|
| Rate for Payer: PHP Commercial |
$36.31
|
| Rate for Payer: PHP Commercial |
$31.43
|
| Rate for Payer: PHP Commercial |
$128.05
|
| Rate for Payer: PHP Commercial |
$51.90
|
| Rate for Payer: Priority Health SBD |
$23.30
|
| Rate for Payer: Priority Health SBD |
$38.47
|
| Rate for Payer: Priority Health SBD |
$26.91
|
| Rate for Payer: Priority Health SBD |
$94.91
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$36.98
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$33.28 |
| Rate for Payer: Aetna Commercial |
$31.43
|
| Rate for Payer: Aetna Commercial |
$51.90
|
| Rate for Payer: Aetna Commercial |
$36.31
|
| Rate for Payer: Aetna Commercial |
$128.05
|
| Rate for Payer: Aetna Medicare |
$18.49
|
| Rate for Payer: Aetna Medicare |
$30.53
|
| Rate for Payer: Aetna Medicare |
$21.36
|
| Rate for Payer: Aetna Medicare |
$75.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.04
|
| Rate for Payer: BCBS Complete |
$24.42
|
| Rate for Payer: BCBS Complete |
$14.79
|
| Rate for Payer: BCBS Complete |
$60.26
|
| Rate for Payer: BCBS Complete |
$17.09
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$21.23
|
| Rate for Payer: BCN Commercial |
$21.23
|
| Rate for Payer: BCN Commercial |
$21.23
|
| Rate for Payer: BCN Commercial |
$21.23
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Cash Price |
$48.85
|
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cash Price |
$120.52
|
| Rate for Payer: Cash Price |
$48.85
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cofinity Advantage |
$42.74
|
| Rate for Payer: Cofinity Advantage |
$105.45
|
| Rate for Payer: Cofinity Advantage |
$29.90
|
| Rate for Payer: Cofinity Advantage |
$25.89
|
| Rate for Payer: Cofinity Commercial |
$129.56
|
| Rate for Payer: Cofinity Commercial |
$52.51
|
| Rate for Payer: Cofinity Commercial |
$31.80
|
| Rate for Payer: Cofinity Commercial |
$36.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.58
|
| Rate for Payer: Healthscope Commercial |
$38.45
|
| Rate for Payer: Healthscope Commercial |
$135.59
|
| Rate for Payer: Healthscope Commercial |
$54.95
|
| Rate for Payer: Healthscope Commercial |
$33.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.80
|
| Rate for Payer: PHP Commercial |
$36.31
|
| Rate for Payer: PHP Commercial |
$31.43
|
| Rate for Payer: PHP Commercial |
$51.90
|
| Rate for Payer: PHP Commercial |
$128.05
|
| Rate for Payer: Priority Health SBD |
$94.91
|
| Rate for Payer: Priority Health SBD |
$26.91
|
| Rate for Payer: Priority Health SBD |
$38.47
|
| Rate for Payer: Priority Health SBD |
$23.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.98
|
| Rate for Payer: UHC Core |
$13.98
|
| Rate for Payer: UHC Core |
$13.98
|
| Rate for Payer: UHC Core |
$13.98
|
| Rate for Payer: UHC Core |
$13.98
|
| Rate for Payer: UHC Exchange |
$13.98
|
| Rate for Payer: UHC Exchange |
$13.98
|
| Rate for Payer: UHC Exchange |
$13.98
|
| Rate for Payer: UHC Exchange |
$13.98
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$19,207.27
|
|
|
Service Code
|
APR-DRG 1792
|
| Min. Negotiated Rate |
$18,292.64 |
| Max. Negotiated Rate |
$19,207.27 |
| Rate for Payer: BCBS Complete |
$19,207.27
|
| Rate for Payer: Mclaren Medicaid |
$18,292.64
|
| Rate for Payer: Meridian Medicaid |
$19,207.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,292.64
|
| Rate for Payer: UHC Medicaid |
$18,292.64
|
| Rate for Payer: UHCCP Medicaid |
$18,292.64
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$16,209.48
|
|
|
Service Code
|
APR-DRG 1791
|
| Min. Negotiated Rate |
$15,437.60 |
| Max. Negotiated Rate |
$16,209.48 |
| Rate for Payer: BCBS Complete |
$16,209.48
|
| Rate for Payer: Mclaren Medicaid |
$15,437.60
|
| Rate for Payer: Meridian Medicaid |
$16,209.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,437.60
|
| Rate for Payer: UHC Medicaid |
$15,437.60
|
| Rate for Payer: UHCCP Medicaid |
$15,437.60
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$31,170.89
|
|
|
Service Code
|
APR-DRG 1794
|
| Min. Negotiated Rate |
$29,686.57 |
| Max. Negotiated Rate |
$31,170.89 |
| Rate for Payer: BCBS Complete |
$31,170.89
|
| Rate for Payer: Mclaren Medicaid |
$29,686.57
|
| Rate for Payer: Meridian Medicaid |
$31,170.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$29,686.57
|
| Rate for Payer: UHC Medicaid |
$29,686.57
|
| Rate for Payer: UHCCP Medicaid |
$29,686.57
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$23,747.81
|
|
|
Service Code
|
APR-DRG 1793
|
| Min. Negotiated Rate |
$22,616.96 |
| Max. Negotiated Rate |
$23,747.81 |
| Rate for Payer: BCBS Complete |
$23,747.81
|
| Rate for Payer: Mclaren Medicaid |
$22,616.96
|
| Rate for Payer: Meridian Medicaid |
$23,747.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,616.96
|
| Rate for Payer: UHC Medicaid |
$22,616.96
|
| Rate for Payer: UHCCP Medicaid |
$22,616.96
|
|
|
DEGARELIX 120 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$4,755.46
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
96987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,995.94 |
| Max. Negotiated Rate |
$4,279.91 |
| Rate for Payer: Aetna Commercial |
$4,042.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,091.05
|
| Rate for Payer: Cash Price |
$3,804.37
|
| Rate for Payer: Cofinity Advantage |
$3,328.82
|
| Rate for Payer: Cofinity Commercial |
$4,089.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,804.37
|
| Rate for Payer: Healthscope Commercial |
$4,279.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,042.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,566.59
|
| Rate for Payer: PHP Commercial |
$4,042.14
|
| Rate for Payer: Priority Health SBD |
$2,995.94
|
|
|
DEGARELIX 120 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$4,755.46
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
96987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$4,279.91 |
| Rate for Payer: Aetna Commercial |
$4,042.14
|
| Rate for Payer: Aetna Medicare |
$4.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,091.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.58
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS MAPPO |
$4.46
|
| Rate for Payer: BCBS Trust/PPO |
$11.15
|
| Rate for Payer: BCN Commercial |
$11.15
|
| Rate for Payer: BCN Medicare Advantage |
$4.46
|
| Rate for Payer: Cash Price |
$3,804.37
|
| Rate for Payer: Cash Price |
$3,804.37
|
| Rate for Payer: Cofinity Advantage |
$3,328.82
|
| Rate for Payer: Cofinity Commercial |
$4,089.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,804.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$4,279.91
|
| Rate for Payer: Mclaren Medicaid |
$2.33
|
| Rate for Payer: Mclaren Medicare |
$4.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.68
|
| Rate for Payer: Meridian Medicaid |
$4.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,042.14
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,566.59
|
| Rate for Payer: PACE Medicare |
$4.24
|
| Rate for Payer: PACE SWMI |
$4.46
|
| Rate for Payer: PHP Commercial |
$4,042.14
|
| Rate for Payer: PHP Medicare Advantage |
$4.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.04
|
| Rate for Payer: Priority Health Medicare |
$4.46
|
| Rate for Payer: Priority Health SBD |
$2,995.94
|
| Rate for Payer: Priority Health Tiered Network |
$11.23
|
| Rate for Payer: Railroad Medicare Medicare |
$4.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.34
|
| Rate for Payer: UHC Core |
$7.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.46
|
| Rate for Payer: UHC Exchange |
$7.34
|
| Rate for Payer: UHC Medicaid |
$2.33
|
| Rate for Payer: UHCCP Medicaid |
$2.33
|
| Rate for Payer: VA VA |
$4.46
|
|
|
DEGARELIX 80 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$1,523.97
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
96986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$1,371.57 |
| Rate for Payer: Aetna Commercial |
$1,295.37
|
| Rate for Payer: Aetna Medicare |
$4.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$990.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.58
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS MAPPO |
$4.46
|
| Rate for Payer: BCBS Trust/PPO |
$11.15
|
| Rate for Payer: BCN Commercial |
$11.15
|
| Rate for Payer: BCN Medicare Advantage |
$4.46
|
| Rate for Payer: Cash Price |
$1,219.18
|
| Rate for Payer: Cash Price |
$1,219.18
|
| Rate for Payer: Cofinity Advantage |
$1,066.78
|
| Rate for Payer: Cofinity Commercial |
$1,310.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,219.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$1,371.57
|
| Rate for Payer: Mclaren Medicaid |
$2.33
|
| Rate for Payer: Mclaren Medicare |
$4.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.68
|
| Rate for Payer: Meridian Medicaid |
$4.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,295.37
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,142.98
|
| Rate for Payer: PACE Medicare |
$4.24
|
| Rate for Payer: PACE SWMI |
$4.46
|
| Rate for Payer: PHP Commercial |
$1,295.37
|
| Rate for Payer: PHP Medicare Advantage |
$4.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.04
|
| Rate for Payer: Priority Health Medicare |
$4.46
|
| Rate for Payer: Priority Health SBD |
$960.10
|
| Rate for Payer: Priority Health Tiered Network |
$11.23
|
| Rate for Payer: Railroad Medicare Medicare |
$4.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.34
|
| Rate for Payer: UHC Core |
$7.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.46
|
| Rate for Payer: UHC Exchange |
$7.34
|
| Rate for Payer: UHC Medicaid |
$2.33
|
| Rate for Payer: UHCCP Medicaid |
$2.33
|
| Rate for Payer: VA VA |
$4.46
|
|
|
DEGARELIX 80 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$1,523.97
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
96986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$960.10 |
| Max. Negotiated Rate |
$1,371.57 |
| Rate for Payer: Aetna Commercial |
$1,295.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$990.58
|
| Rate for Payer: Cash Price |
$1,219.18
|
| Rate for Payer: Cofinity Advantage |
$1,066.78
|
| Rate for Payer: Cofinity Commercial |
$1,310.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,219.18
|
| Rate for Payer: Healthscope Commercial |
$1,371.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,295.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,142.98
|
| Rate for Payer: PHP Commercial |
$1,295.37
|
| Rate for Payer: Priority Health SBD |
$960.10
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$9,231.85
|
|
|
Service Code
|
APR-DRG 0423
|
| Min. Negotiated Rate |
$8,792.24 |
| Max. Negotiated Rate |
$9,231.85 |
| Rate for Payer: BCBS Complete |
$9,231.85
|
| Rate for Payer: Mclaren Medicaid |
$8,792.24
|
| Rate for Payer: Meridian Medicaid |
$9,231.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,792.24
|
| Rate for Payer: UHC Medicaid |
$8,792.24
|
| Rate for Payer: UHCCP Medicaid |
$8,792.24
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$6,387.14
|
|
|
Service Code
|
APR-DRG 0422
|
| Min. Negotiated Rate |
$6,082.99 |
| Max. Negotiated Rate |
$6,387.14 |
| Rate for Payer: BCBS Complete |
$6,387.14
|
| Rate for Payer: Mclaren Medicaid |
$6,082.99
|
| Rate for Payer: Meridian Medicaid |
$6,387.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,082.99
|
| Rate for Payer: UHC Medicaid |
$6,082.99
|
| Rate for Payer: UHCCP Medicaid |
$6,082.99
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$5,943.97
|
|
|
Service Code
|
APR-DRG 0421
|
| Min. Negotiated Rate |
$5,660.93 |
| Max. Negotiated Rate |
$5,943.97 |
| Rate for Payer: BCBS Complete |
$5,943.97
|
| Rate for Payer: Mclaren Medicaid |
$5,660.93
|
| Rate for Payer: Meridian Medicaid |
$5,943.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,660.93
|
| Rate for Payer: UHC Medicaid |
$5,660.93
|
| Rate for Payer: UHCCP Medicaid |
$5,660.93
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$9,589.02
|
|
|
Service Code
|
APR-DRG 0424
|
| Min. Negotiated Rate |
$9,132.40 |
| Max. Negotiated Rate |
$9,589.02 |
| Rate for Payer: BCBS Complete |
$9,589.02
|
| Rate for Payer: Mclaren Medicaid |
$9,132.40
|
| Rate for Payer: Meridian Medicaid |
$9,589.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,132.40
|
| Rate for Payer: UHC Medicaid |
$9,132.40
|
| Rate for Payer: UHCCP Medicaid |
$9,132.40
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$42,593.20
|
|
|
Service Code
|
MSDRG 056
|
| Min. Negotiated Rate |
$17,605.82 |
| Max. Negotiated Rate |
$42,593.20 |
| Rate for Payer: Aetna Medicare |
$19,273.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,165.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,165.55
|
| Rate for Payer: BCBS MAPPO |
$18,532.44
|
| Rate for Payer: BCBS Trust/PPO |
$42,593.20
|
| Rate for Payer: BCN Commercial |
$42,593.20
|
| Rate for Payer: BCN Medicare Advantage |
$18,532.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,532.44
|
| Rate for Payer: Mclaren Medicare |
$18,532.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,459.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,312.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,385.68
|
| Rate for Payer: Nomi Health Commercial |
$29,967.99
|
| Rate for Payer: PACE Medicare |
$17,605.82
|
| Rate for Payer: PACE SWMI |
$18,532.44
|
| Rate for Payer: PHP Medicare Advantage |
$18,532.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,453.34
|
| Rate for Payer: Priority Health Medicare |
$18,532.44
|
| Rate for Payer: Priority Health Tiered Network |
$29,962.67
|
| Rate for Payer: Railroad Medicare Medicare |
$18,532.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,866.53
|
| Rate for Payer: UHC Core |
$31,680.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,532.44
|
| Rate for Payer: UHC Exchange |
$25,872.36
|
| Rate for Payer: VA VA |
$18,532.44
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$31,371.40
|
|
|
Service Code
|
MSDRG 057
|
| Min. Negotiated Rate |
$10,062.11 |
| Max. Negotiated Rate |
$31,371.40 |
| Rate for Payer: Aetna Medicare |
$11,015.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,239.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,239.61
|
| Rate for Payer: BCBS MAPPO |
$10,591.69
|
| Rate for Payer: BCBS Trust/PPO |
$31,371.40
|
| Rate for Payer: BCN Commercial |
$31,371.40
|
| Rate for Payer: BCN Medicare Advantage |
$10,591.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,591.69
|
| Rate for Payer: Mclaren Medicare |
$10,591.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,121.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,180.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,650.86
|
| Rate for Payer: Nomi Health Commercial |
$16,713.24
|
| Rate for Payer: PACE Medicare |
$10,062.11
|
| Rate for Payer: PACE SWMI |
$10,591.69
|
| Rate for Payer: PHP Medicare Advantage |
$10,591.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,887.84
|
| Rate for Payer: Priority Health Medicare |
$10,591.69
|
| Rate for Payer: Priority Health Tiered Network |
$16,710.27
|
| Rate for Payer: Railroad Medicare Medicare |
$10,591.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,118.28
|
| Rate for Payer: UHC Core |
$17,668.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,591.69
|
| Rate for Payer: UHC Exchange |
$14,429.10
|
| Rate for Payer: VA VA |
$10,591.69
|
|
|
DEIONIZED WATER
|
Facility
|
IP
|
$889.48
|
|
|
Service Code
|
NDC 09900000039
|
| Hospital Charge Code |
150892
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$560.37 |
| Max. Negotiated Rate |
$800.53 |
| Rate for Payer: Aetna Commercial |
$756.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.16
|
| Rate for Payer: Cash Price |
$711.58
|
| Rate for Payer: Cofinity Advantage |
$622.64
|
| Rate for Payer: Cofinity Commercial |
$764.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$711.58
|
| Rate for Payer: Healthscope Commercial |
$800.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$756.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$667.11
|
| Rate for Payer: PHP Commercial |
$756.06
|
| Rate for Payer: Priority Health SBD |
$560.37
|
|
|
DEIONIZED WATER
|
Facility
|
OP
|
$889.48
|
|
|
Service Code
|
NDC 09900000039
|
| Hospital Charge Code |
150892
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$349.57 |
| Max. Negotiated Rate |
$800.53 |
| Rate for Payer: Aetna Commercial |
$756.06
|
| Rate for Payer: Aetna Medicare |
$444.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.16
|
| Rate for Payer: BCBS Complete |
$355.79
|
| Rate for Payer: Cash Price |
$711.58
|
| Rate for Payer: Cofinity Advantage |
$622.64
|
| Rate for Payer: Cofinity Commercial |
$764.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$711.58
|
| Rate for Payer: Healthscope Commercial |
$800.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$711.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$756.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$667.11
|
| Rate for Payer: PHP Commercial |
$756.06
|
| Rate for Payer: Priority Health SBD |
$560.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.16
|
| Rate for Payer: UHC Core |
$463.42
|
| Rate for Payer: UHC Exchange |
$349.57
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$8,340.65
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
106804
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,254.61 |
| Max. Negotiated Rate |
$7,506.59 |
| Rate for Payer: Aetna Commercial |
$7,089.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,421.42
|
| Rate for Payer: Cash Price |
$6,672.52
|
| Rate for Payer: Cofinity Advantage |
$5,838.45
|
| Rate for Payer: Cofinity Commercial |
$7,172.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,672.52
|
| Rate for Payer: Healthscope Commercial |
$7,506.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,089.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,255.49
|
| Rate for Payer: PHP Commercial |
$7,089.55
|
| Rate for Payer: Priority Health SBD |
$5,254.61
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$8,340.65
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
106804
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$7,506.59 |
| Rate for Payer: Aetna Commercial |
$7,089.55
|
| Rate for Payer: Aetna Medicare |
$30.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,421.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.89
|
| Rate for Payer: BCBS Complete |
$16.21
|
| Rate for Payer: BCBS MAPPO |
$29.51
|
| Rate for Payer: BCBS Trust/PPO |
$73.90
|
| Rate for Payer: BCN Commercial |
$73.90
|
| Rate for Payer: BCN Medicare Advantage |
$29.51
|
| Rate for Payer: Cash Price |
$6,672.52
|
| Rate for Payer: Cash Price |
$6,672.52
|
| Rate for Payer: Cofinity Advantage |
$5,838.45
|
| Rate for Payer: Cofinity Commercial |
$7,172.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,672.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.51
|
| Rate for Payer: Healthscope Commercial |
$7,506.59
|
| Rate for Payer: Mclaren Medicaid |
$15.43
|
| Rate for Payer: Mclaren Medicare |
$29.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.99
|
| Rate for Payer: Meridian Medicaid |
$30.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,089.55
|
| Rate for Payer: Nomi Health Commercial |
$88.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,255.49
|
| Rate for Payer: PACE Medicare |
$28.03
|
| Rate for Payer: PACE SWMI |
$29.51
|
| Rate for Payer: PHP Commercial |
$7,089.55
|
| Rate for Payer: PHP Medicare Advantage |
$29.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$92.67
|
| Rate for Payer: Priority Health Medicare |
$29.51
|
| Rate for Payer: Priority Health SBD |
$5,254.61
|
| Rate for Payer: Priority Health Tiered Network |
$74.14
|
| Rate for Payer: Railroad Medicare Medicare |
$29.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.61
|
| Rate for Payer: UHC Core |
$48.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.51
|
| Rate for Payer: UHC Exchange |
$48.61
|
| Rate for Payer: UHC Medicaid |
$15.43
|
| Rate for Payer: UHCCP Medicaid |
$15.43
|
| Rate for Payer: VA VA |
$29.51
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$5,581.28
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
105502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,516.21 |
| Max. Negotiated Rate |
$5,023.15 |
| Rate for Payer: Aetna Commercial |
$4,744.09
|
| Rate for Payer: Aetna Commercial |
$4,885.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,627.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,736.30
|
| Rate for Payer: Cash Price |
$4,465.02
|
| Rate for Payer: Cash Price |
$4,598.53
|
| Rate for Payer: Cofinity Advantage |
$3,906.90
|
| Rate for Payer: Cofinity Advantage |
$4,023.71
|
| Rate for Payer: Cofinity Commercial |
$4,799.90
|
| Rate for Payer: Cofinity Commercial |
$4,943.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,598.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,465.02
|
| Rate for Payer: Healthscope Commercial |
$5,173.34
|
| Rate for Payer: Healthscope Commercial |
$5,023.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,744.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,885.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,185.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,311.12
|
| Rate for Payer: PHP Commercial |
$4,744.09
|
| Rate for Payer: PHP Commercial |
$4,885.94
|
| Rate for Payer: Priority Health SBD |
$3,516.21
|
| Rate for Payer: Priority Health SBD |
$3,621.34
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,581.28
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
105502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$5,023.15 |
| Rate for Payer: Aetna Commercial |
$4,744.09
|
| Rate for Payer: Aetna Commercial |
$4,885.94
|
| Rate for Payer: Aetna Medicare |
$30.69
|
| Rate for Payer: Aetna Medicare |
$30.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,736.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,627.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.89
|
| Rate for Payer: BCBS Complete |
$16.21
|
| Rate for Payer: BCBS Complete |
$16.21
|
| Rate for Payer: BCBS MAPPO |
$29.51
|
| Rate for Payer: BCBS MAPPO |
$29.51
|
| Rate for Payer: BCBS Trust/PPO |
$73.90
|
| Rate for Payer: BCBS Trust/PPO |
$73.90
|
| Rate for Payer: BCN Commercial |
$73.90
|
| Rate for Payer: BCN Commercial |
$73.90
|
| Rate for Payer: BCN Medicare Advantage |
$29.51
|
| Rate for Payer: BCN Medicare Advantage |
$29.51
|
| Rate for Payer: Cash Price |
$4,465.02
|
| Rate for Payer: Cash Price |
$4,598.53
|
| Rate for Payer: Cash Price |
$4,598.53
|
| Rate for Payer: Cash Price |
$4,465.02
|
| Rate for Payer: Cofinity Advantage |
$4,023.71
|
| Rate for Payer: Cofinity Advantage |
$3,906.90
|
| Rate for Payer: Cofinity Commercial |
$4,943.42
|
| Rate for Payer: Cofinity Commercial |
$4,799.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,465.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,598.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.51
|
| Rate for Payer: Healthscope Commercial |
$5,023.15
|
| Rate for Payer: Healthscope Commercial |
$5,173.34
|
| Rate for Payer: Mclaren Medicaid |
$15.43
|
| Rate for Payer: Mclaren Medicaid |
$15.43
|
| Rate for Payer: Mclaren Medicare |
$29.51
|
| Rate for Payer: Mclaren Medicare |
$29.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.99
|
| Rate for Payer: Meridian Medicaid |
$30.99
|
| Rate for Payer: Meridian Medicaid |
$30.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,744.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,885.94
|
| Rate for Payer: Nomi Health Commercial |
$88.53
|
| Rate for Payer: Nomi Health Commercial |
$88.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,185.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,311.12
|
| Rate for Payer: PACE Medicare |
$28.03
|
| Rate for Payer: PACE Medicare |
$28.03
|
| Rate for Payer: PACE SWMI |
$29.51
|
| Rate for Payer: PACE SWMI |
$29.51
|
| Rate for Payer: PHP Commercial |
$4,885.94
|
| Rate for Payer: PHP Commercial |
$4,744.09
|
| Rate for Payer: PHP Medicare Advantage |
$29.51
|
| Rate for Payer: PHP Medicare Advantage |
$29.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$92.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$92.67
|
| Rate for Payer: Priority Health Medicare |
$29.51
|
| Rate for Payer: Priority Health Medicare |
$29.51
|
| Rate for Payer: Priority Health SBD |
$3,621.34
|
| Rate for Payer: Priority Health SBD |
$3,516.21
|
| Rate for Payer: Priority Health Tiered Network |
$74.14
|
| Rate for Payer: Priority Health Tiered Network |
$74.14
|
| Rate for Payer: Railroad Medicare Medicare |
$29.51
|
| Rate for Payer: Railroad Medicare Medicare |
$29.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.61
|
| Rate for Payer: UHC Core |
$48.61
|
| Rate for Payer: UHC Core |
$48.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.51
|
| Rate for Payer: UHC Exchange |
$48.61
|
| Rate for Payer: UHC Exchange |
$48.61
|
| Rate for Payer: UHC Medicaid |
$15.43
|
| Rate for Payer: UHC Medicaid |
$15.43
|
| Rate for Payer: UHCCP Medicaid |
$15.43
|
| Rate for Payer: UHCCP Medicaid |
$15.43
|
| Rate for Payer: VA VA |
$29.51
|
| Rate for Payer: VA VA |
$29.51
|
|
|
DENOSUMAB-BMWO 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$7,924.39
|
|
|
Service Code
|
HCPCS Q5157
|
| Hospital Charge Code |
211791
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,992.37 |
| Max. Negotiated Rate |
$7,131.95 |
| Rate for Payer: Aetna Commercial |
$6,735.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,150.85
|
| Rate for Payer: Cash Price |
$6,339.51
|
| Rate for Payer: Cofinity Advantage |
$5,547.07
|
| Rate for Payer: Cofinity Commercial |
$6,814.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,339.51
|
| Rate for Payer: Healthscope Commercial |
$7,131.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,735.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,943.29
|
| Rate for Payer: PHP Commercial |
$6,735.73
|
| Rate for Payer: Priority Health SBD |
$4,992.37
|
|
