|
ALTEPLASE 100 MG IV INFUSION FOR STROKE
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna Medicare |
$98.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,743.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$235.41
|
| Rate for Payer: BCN Commercial |
$235.41
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Advantage |
$20,185.20
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Mclaren Medicaid |
$49.73
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$99.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$297.89
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health SBD |
$18,166.68
|
| Rate for Payer: Priority Health Tiered Network |
$238.31
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.82
|
| Rate for Payer: UHC Core |
$154.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$154.82
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: VA VA |
$95.09
|
|
|
ALTEPLASE 100 MG IV INFUSION FOR STROKE
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18,166.68 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,743.40
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Advantage |
$20,185.20
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: Priority Health SBD |
$18,166.68
|
|
|
ALTEPLASE 100MG IV SOLUTION FOR PE
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18,166.68 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,743.40
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Advantage |
$20,185.20
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: Priority Health SBD |
$18,166.68
|
|
|
ALTEPLASE 100MG IV SOLUTION FOR PE
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna Medicare |
$98.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,743.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$235.41
|
| Rate for Payer: BCN Commercial |
$235.41
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Advantage |
$20,185.20
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Mclaren Medicaid |
$49.73
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$99.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$297.89
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health SBD |
$18,166.68
|
| Rate for Payer: Priority Health Tiered Network |
$238.31
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.82
|
| Rate for Payer: UHC Core |
$154.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$154.82
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: VA VA |
$95.09
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION
|
Facility
|
IP
|
$672.98
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
31310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$423.98 |
| Max. Negotiated Rate |
$605.68 |
| Rate for Payer: Aetna Commercial |
$572.03
|
| Rate for Payer: Aetna Commercial |
$571.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.44
|
| Rate for Payer: Cash Price |
$538.34
|
| Rate for Payer: Cash Price |
$538.38
|
| Rate for Payer: Cofinity Advantage |
$471.09
|
| Rate for Payer: Cofinity Advantage |
$471.05
|
| Rate for Payer: Cofinity Commercial |
$578.72
|
| Rate for Payer: Cofinity Commercial |
$578.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.38
|
| Rate for Payer: Healthscope Commercial |
$605.64
|
| Rate for Payer: Healthscope Commercial |
$605.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$571.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$504.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$504.70
|
| Rate for Payer: PHP Commercial |
$571.99
|
| Rate for Payer: PHP Commercial |
$572.03
|
| Rate for Payer: Priority Health SBD |
$423.95
|
| Rate for Payer: Priority Health SBD |
$423.98
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION
|
Facility
|
OP
|
$672.98
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
31310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$605.68 |
| Rate for Payer: Aetna Commercial |
$572.03
|
| Rate for Payer: Aetna Commercial |
$571.99
|
| Rate for Payer: Aetna Medicare |
$98.89
|
| Rate for Payer: Aetna Medicare |
$98.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$235.41
|
| Rate for Payer: BCBS Trust/PPO |
$235.41
|
| Rate for Payer: BCN Commercial |
$235.41
|
| Rate for Payer: BCN Commercial |
$235.41
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$538.34
|
| Rate for Payer: Cash Price |
$538.34
|
| Rate for Payer: Cash Price |
$538.38
|
| Rate for Payer: Cash Price |
$538.38
|
| Rate for Payer: Cofinity Advantage |
$471.09
|
| Rate for Payer: Cofinity Advantage |
$471.05
|
| Rate for Payer: Cofinity Commercial |
$578.76
|
| Rate for Payer: Cofinity Commercial |
$578.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$605.64
|
| Rate for Payer: Healthscope Commercial |
$605.68
|
| Rate for Payer: Mclaren Medicaid |
$49.73
|
| Rate for Payer: Mclaren Medicaid |
$49.73
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$99.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$571.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.03
|
| Rate for Payer: Nomi Health Commercial |
$285.27
|
| Rate for Payer: Nomi Health Commercial |
$285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$504.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$504.70
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$571.99
|
| Rate for Payer: PHP Commercial |
$572.03
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$297.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$297.89
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health SBD |
$423.98
|
| Rate for Payer: Priority Health SBD |
$423.95
|
| Rate for Payer: Priority Health Tiered Network |
$238.31
|
| Rate for Payer: Priority Health Tiered Network |
$238.31
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.82
|
| Rate for Payer: UHC Core |
$154.82
|
| Rate for Payer: UHC Core |
$154.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$154.82
|
| Rate for Payer: UHC Exchange |
$154.82
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: VA VA |
$95.09
|
| Rate for Payer: VA VA |
$95.09
|
|
|
ALTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,083.34 |
| Max. Negotiated Rate |
$12,976.20 |
| Rate for Payer: Aetna Commercial |
$12,255.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,371.70
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Advantage |
$10,092.60
|
| Rate for Payer: Cofinity Commercial |
$12,399.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Healthscope Commercial |
$12,976.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,813.50
|
| Rate for Payer: PHP Commercial |
$12,255.30
|
| Rate for Payer: Priority Health SBD |
$9,083.34
|
|
|
ALTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$12,976.20 |
| Rate for Payer: Aetna Commercial |
$12,255.30
|
| Rate for Payer: Aetna Medicare |
$98.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,371.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$235.41
|
| Rate for Payer: BCN Commercial |
$235.41
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Advantage |
$10,092.60
|
| Rate for Payer: Cofinity Commercial |
$12,399.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$12,976.20
|
| Rate for Payer: Mclaren Medicaid |
$49.73
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$99.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: Nomi Health Commercial |
$285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,813.50
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$12,255.30
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$297.89
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health SBD |
$9,083.34
|
| Rate for Payer: Priority Health Tiered Network |
$238.31
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.82
|
| Rate for Payer: UHC Core |
$154.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$154.82
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: VA VA |
$95.09
|
|
|
ALTEPLASE INFUSION FOR CARDIAC ARREST
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
300766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna Medicare |
$98.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,743.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$235.41
|
| Rate for Payer: BCN Commercial |
$235.41
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Advantage |
$20,185.20
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Mclaren Medicaid |
$49.73
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$99.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$297.89
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health SBD |
$18,166.68
|
| Rate for Payer: Priority Health Tiered Network |
$238.31
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.82
|
| Rate for Payer: UHC Core |
$154.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$154.82
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: VA VA |
$95.09
|
|
|
ALTEPLASE INFUSION FOR CARDIAC ARREST
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
300766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18,166.68 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,743.40
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Advantage |
$20,185.20
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: Priority Health SBD |
$18,166.68
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
IP
|
$5,339.72
|
|
|
Service Code
|
APR-DRG 0522
|
| Min. Negotiated Rate |
$5,085.44 |
| Max. Negotiated Rate |
$5,339.72 |
| Rate for Payer: BCBS Complete |
$5,339.72
|
| Rate for Payer: Mclaren Medicaid |
$5,085.44
|
| Rate for Payer: Meridian Medicaid |
$5,339.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,085.44
|
| Rate for Payer: UHC Medicaid |
$5,085.44
|
| Rate for Payer: UHCCP Medicaid |
$5,085.44
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
IP
|
$3,948.89
|
|
|
Service Code
|
APR-DRG 0521
|
| Min. Negotiated Rate |
$3,760.85 |
| Max. Negotiated Rate |
$3,948.89 |
| Rate for Payer: BCBS Complete |
$3,948.89
|
| Rate for Payer: Mclaren Medicaid |
$3,760.85
|
| Rate for Payer: Meridian Medicaid |
$3,948.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,760.85
|
| Rate for Payer: UHC Medicaid |
$3,760.85
|
| Rate for Payer: UHCCP Medicaid |
$3,760.85
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
IP
|
$7,336.52
|
|
|
Service Code
|
APR-DRG 0523
|
| Min. Negotiated Rate |
$6,987.16 |
| Max. Negotiated Rate |
$7,336.52 |
| Rate for Payer: BCBS Complete |
$7,336.52
|
| Rate for Payer: Mclaren Medicaid |
$6,987.16
|
| Rate for Payer: Meridian Medicaid |
$7,336.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,987.16
|
| Rate for Payer: UHC Medicaid |
$6,987.16
|
| Rate for Payer: UHCCP Medicaid |
$6,987.16
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
IP
|
$12,175.75
|
|
|
Service Code
|
APR-DRG 0524
|
| Min. Negotiated Rate |
$11,595.95 |
| Max. Negotiated Rate |
$12,175.75 |
| Rate for Payer: BCBS Complete |
$12,175.75
|
| Rate for Payer: Mclaren Medicaid |
$11,595.95
|
| Rate for Payer: Meridian Medicaid |
$12,175.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,595.95
|
| Rate for Payer: UHC Medicaid |
$11,595.95
|
| Rate for Payer: UHCCP Medicaid |
$11,595.95
|
|
|
ALUMINUM HYDROX-MAGNESIUM CARB 95 MG-358 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$18.39
|
|
|
Service Code
|
NDC 00904772714
|
| Hospital Charge Code |
24314
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Aetna Commercial |
$15.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.95
|
| Rate for Payer: Cash Price |
$14.71
|
| Rate for Payer: Cofinity Advantage |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$15.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.79
|
| Rate for Payer: PHP Commercial |
$15.63
|
| Rate for Payer: Priority Health SBD |
$11.59
|
|
|
ALUMINUM HYDROX-MAGNESIUM CARB 95 MG-358 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$18.39
|
|
|
Service Code
|
NDC 00904772714
|
| Hospital Charge Code |
24314
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Aetna Commercial |
$15.63
|
| Rate for Payer: Aetna Medicare |
$9.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.95
|
| Rate for Payer: BCBS Complete |
$7.36
|
| Rate for Payer: Cash Price |
$14.71
|
| Rate for Payer: Cofinity Advantage |
$12.87
|
| Rate for Payer: Cofinity Commercial |
$15.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$16.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.79
|
| Rate for Payer: PHP Commercial |
$15.63
|
| Rate for Payer: Priority Health SBD |
$11.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.95
|
| Rate for Payer: UHC Core |
$9.58
|
| Rate for Payer: UHC Exchange |
$7.23
|
|
|
ALUMINUM HYDROX-MAGNESIUM CARB 95 MG-358 MG/15 ML ORAL SUSPENSION
|
Facility
|
OP
|
$28.90
|
|
|
Service Code
|
NDC 00088117112
|
| Hospital Charge Code |
24314
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$24.57
|
| Rate for Payer: Aetna Medicare |
$14.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.79
|
| Rate for Payer: BCBS Complete |
$11.56
|
| Rate for Payer: Cash Price |
$23.12
|
| Rate for Payer: Cofinity Advantage |
$20.23
|
| Rate for Payer: Cofinity Commercial |
$24.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.12
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.68
|
| Rate for Payer: PHP Commercial |
$24.57
|
| Rate for Payer: Priority Health SBD |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.79
|
| Rate for Payer: UHC Core |
$15.06
|
| Rate for Payer: UHC Exchange |
$11.36
|
|
|
ALUMINUM HYDROX-MAGNESIUM CARB 95 MG-358 MG/15 ML ORAL SUSPENSION
|
Facility
|
IP
|
$28.90
|
|
|
Service Code
|
NDC 00088117112
|
| Hospital Charge Code |
24314
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$24.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.79
|
| Rate for Payer: Cash Price |
$23.12
|
| Rate for Payer: Cofinity Advantage |
$20.23
|
| Rate for Payer: Cofinity Commercial |
$24.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.12
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.68
|
| Rate for Payer: PHP Commercial |
$24.57
|
| Rate for Payer: Priority Health SBD |
$18.21
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 121176130
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$9.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.03
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Advantage |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health SBD |
$11.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.03
|
| Rate for Payer: UHC Core |
$9.64
|
| Rate for Payer: UHC Exchange |
$7.27
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$18.23
|
|
|
Service Code
|
NDC 57237031631
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$16.41 |
| Rate for Payer: Aetna Commercial |
$15.50
|
| Rate for Payer: Aetna Medicare |
$9.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.85
|
| Rate for Payer: BCBS Complete |
$7.29
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cofinity Advantage |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$15.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Healthscope Commercial |
$16.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.67
|
| Rate for Payer: PHP Commercial |
$15.50
|
| Rate for Payer: Priority Health SBD |
$11.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.85
|
| Rate for Payer: UHC Core |
$9.50
|
| Rate for Payer: UHC Exchange |
$7.16
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
IP
|
$18.23
|
|
|
Service Code
|
NDC 57237031631
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$16.41 |
| Rate for Payer: Aetna Commercial |
$15.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.85
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cofinity Advantage |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$15.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Healthscope Commercial |
$16.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.67
|
| Rate for Payer: PHP Commercial |
$15.50
|
| Rate for Payer: Priority Health SBD |
$11.48
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$14.38
|
|
|
Service Code
|
NDC 00536131783
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$12.94 |
| Rate for Payer: Aetna Commercial |
$12.22
|
| Rate for Payer: Aetna Medicare |
$7.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.35
|
| Rate for Payer: BCBS Complete |
$5.75
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cofinity Advantage |
$10.07
|
| Rate for Payer: Cofinity Commercial |
$12.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.50
|
| Rate for Payer: Healthscope Commercial |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.79
|
| Rate for Payer: PHP Commercial |
$12.22
|
| Rate for Payer: Priority Health SBD |
$9.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.35
|
| Rate for Payer: UHC Core |
$7.49
|
| Rate for Payer: UHC Exchange |
$5.65
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$15.98
|
|
|
Service Code
|
NDC 57896062912
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$14.38 |
| Rate for Payer: Aetna Commercial |
$13.58
|
| Rate for Payer: Aetna Medicare |
$7.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.39
|
| Rate for Payer: BCBS Complete |
$6.39
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cofinity Advantage |
$11.19
|
| Rate for Payer: Cofinity Commercial |
$13.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.78
|
| Rate for Payer: Healthscope Commercial |
$14.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.98
|
| Rate for Payer: PHP Commercial |
$13.58
|
| Rate for Payer: Priority Health SBD |
$10.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.39
|
| Rate for Payer: UHC Core |
$8.33
|
| Rate for Payer: UHC Exchange |
$6.28
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$12.83
|
|
|
Service Code
|
NDC 00904732562
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Aetna Commercial |
$10.91
|
| Rate for Payer: Aetna Medicare |
$6.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.34
|
| Rate for Payer: BCBS Complete |
$5.13
|
| Rate for Payer: Cash Price |
$10.26
|
| Rate for Payer: Cofinity Advantage |
$8.98
|
| Rate for Payer: Cofinity Commercial |
$11.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.26
|
| Rate for Payer: Healthscope Commercial |
$11.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.62
|
| Rate for Payer: PHP Commercial |
$10.91
|
| Rate for Payer: Priority Health SBD |
$8.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.34
|
| Rate for Payer: UHC Core |
$6.68
|
| Rate for Payer: UHC Exchange |
$5.04
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
IP
|
$15.98
|
|
|
Service Code
|
NDC 57896062912
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$14.38 |
| Rate for Payer: Aetna Commercial |
$13.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.39
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cofinity Advantage |
$11.19
|
| Rate for Payer: Cofinity Commercial |
$13.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.78
|
| Rate for Payer: Healthscope Commercial |
$14.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.98
|
| Rate for Payer: PHP Commercial |
$13.58
|
| Rate for Payer: Priority Health SBD |
$10.07
|
|
