|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET
|
Facility
|
IP
|
$226.95
|
|
|
Service Code
|
NDC 00904717207
|
| Hospital Charge Code |
39255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.98 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Aetna Commercial |
$192.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.52
|
| Rate for Payer: Cash Price |
$181.56
|
| Rate for Payer: Cofinity Advantage |
$158.87
|
| Rate for Payer: Cofinity Commercial |
$195.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.56
|
| Rate for Payer: Healthscope Commercial |
$204.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.21
|
| Rate for Payer: PHP Commercial |
$192.91
|
| Rate for Payer: Priority Health SBD |
$142.98
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET
|
Facility
|
OP
|
$89.28
|
|
|
Service Code
|
NDC 42385095330
|
| Hospital Charge Code |
39255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna Medicare |
$44.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: BCBS Complete |
$35.71
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Advantage |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$80.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.96
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.03
|
| Rate for Payer: UHC Core |
$46.51
|
| Rate for Payer: UHC Exchange |
$35.09
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET
|
Facility
|
OP
|
$226.95
|
|
|
Service Code
|
NDC 00904717207
|
| Hospital Charge Code |
39255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.19 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Aetna Commercial |
$192.91
|
| Rate for Payer: Aetna Medicare |
$113.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.52
|
| Rate for Payer: BCBS Complete |
$90.78
|
| Rate for Payer: Cash Price |
$181.56
|
| Rate for Payer: Cofinity Advantage |
$158.87
|
| Rate for Payer: Cofinity Commercial |
$195.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.56
|
| Rate for Payer: Healthscope Commercial |
$204.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.21
|
| Rate for Payer: PHP Commercial |
$192.91
|
| Rate for Payer: Priority Health SBD |
$142.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.52
|
| Rate for Payer: UHC Core |
$118.24
|
| Rate for Payer: UHC Exchange |
$89.19
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET
|
Facility
|
OP
|
$6,646.02
|
|
|
Service Code
|
NDC 61958070101
|
| Hospital Charge Code |
39255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,611.89 |
| Max. Negotiated Rate |
$5,981.42 |
| Rate for Payer: Aetna Commercial |
$5,649.12
|
| Rate for Payer: Aetna Medicare |
$3,323.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,319.91
|
| Rate for Payer: BCBS Complete |
$2,658.41
|
| Rate for Payer: Cash Price |
$5,316.82
|
| Rate for Payer: Cofinity Advantage |
$4,652.21
|
| Rate for Payer: Cofinity Commercial |
$5,715.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,316.82
|
| Rate for Payer: Healthscope Commercial |
$5,981.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,316.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,649.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,984.52
|
| Rate for Payer: PHP Commercial |
$5,649.12
|
| Rate for Payer: Priority Health SBD |
$4,186.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,319.91
|
| Rate for Payer: UHC Core |
$3,462.58
|
| Rate for Payer: UHC Exchange |
$2,611.89
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET
|
Facility
|
IP
|
$6,646.02
|
|
|
Service Code
|
NDC 61958070101
|
| Hospital Charge Code |
39255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,186.99 |
| Max. Negotiated Rate |
$5,981.42 |
| Rate for Payer: Aetna Commercial |
$5,649.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,319.91
|
| Rate for Payer: Cash Price |
$5,316.82
|
| Rate for Payer: Cofinity Advantage |
$4,652.21
|
| Rate for Payer: Cofinity Commercial |
$5,715.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,316.82
|
| Rate for Payer: Healthscope Commercial |
$5,981.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,649.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,984.52
|
| Rate for Payer: PHP Commercial |
$5,649.12
|
| Rate for Payer: Priority Health SBD |
$4,186.99
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET
|
Facility
|
IP
|
$89.28
|
|
|
Service Code
|
NDC 42385095330
|
| Hospital Charge Code |
39255
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Advantage |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$80.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.96
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health SBD |
$56.25
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$57.56
|
|
|
Service Code
|
NDC 00143978601
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.26 |
| Max. Negotiated Rate |
$51.80 |
| Rate for Payer: Aetna Commercial |
$48.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.41
|
| Rate for Payer: Cash Price |
$46.05
|
| Rate for Payer: Cofinity Advantage |
$40.29
|
| Rate for Payer: Cofinity Commercial |
$49.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.05
|
| Rate for Payer: Healthscope Commercial |
$51.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.17
|
| Rate for Payer: PHP Commercial |
$48.93
|
| Rate for Payer: Priority Health SBD |
$36.26
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$57.56
|
|
|
Service Code
|
NDC 00143978610
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$51.80 |
| Rate for Payer: Aetna Commercial |
$48.93
|
| Rate for Payer: Aetna Medicare |
$28.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.41
|
| Rate for Payer: BCBS Complete |
$23.02
|
| Rate for Payer: Cash Price |
$46.05
|
| Rate for Payer: Cofinity Advantage |
$40.29
|
| Rate for Payer: Cofinity Commercial |
$49.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.05
|
| Rate for Payer: Healthscope Commercial |
$51.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.17
|
| Rate for Payer: PHP Commercial |
$48.93
|
| Rate for Payer: Priority Health SBD |
$36.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.41
|
| Rate for Payer: UHC Core |
$29.99
|
| Rate for Payer: UHC Exchange |
$22.62
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$57.56
|
|
|
Service Code
|
NDC 00143978610
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.26 |
| Max. Negotiated Rate |
$51.80 |
| Rate for Payer: Aetna Commercial |
$48.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.41
|
| Rate for Payer: Cash Price |
$46.05
|
| Rate for Payer: Cofinity Advantage |
$40.29
|
| Rate for Payer: Cofinity Commercial |
$49.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.05
|
| Rate for Payer: Healthscope Commercial |
$51.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.17
|
| Rate for Payer: PHP Commercial |
$48.93
|
| Rate for Payer: Priority Health SBD |
$36.26
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$57.56
|
|
|
Service Code
|
NDC 00143978601
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$51.80 |
| Rate for Payer: Aetna Commercial |
$48.93
|
| Rate for Payer: Aetna Medicare |
$28.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.41
|
| Rate for Payer: BCBS Complete |
$23.02
|
| Rate for Payer: Cash Price |
$46.05
|
| Rate for Payer: Cofinity Advantage |
$40.29
|
| Rate for Payer: Cofinity Commercial |
$49.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.05
|
| Rate for Payer: Healthscope Commercial |
$51.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.17
|
| Rate for Payer: PHP Commercial |
$48.93
|
| Rate for Payer: Priority Health SBD |
$36.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.41
|
| Rate for Payer: UHC Core |
$29.99
|
| Rate for Payer: UHC Exchange |
$22.62
|
|
|
ENDOCERVICAL CURETTAGE (NOT DONE AS PART OF A DILATION AND CURETTAGE)
|
Facility
|
OP
|
$2,967.88
|
|
|
Service Code
|
CPT 57505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$2,967.88 |
| Rate for Payer: Aetna Medicare |
$954.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,147.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,147.17
|
| Rate for Payer: BCBS Complete |
$504.02
|
| Rate for Payer: BCBS MAPPO |
$917.74
|
| Rate for Payer: BCBS Trust/PPO |
$580.01
|
| Rate for Payer: BCCCP Commercial |
$145.60
|
| Rate for Payer: BCN Commercial |
$580.01
|
| Rate for Payer: BCN Medicare Advantage |
$917.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$917.74
|
| Rate for Payer: Mclaren Medicaid |
$479.98
|
| Rate for Payer: Mclaren Medicare |
$917.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$963.63
|
| Rate for Payer: Meridian Medicaid |
$963.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,055.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,009.51
|
| Rate for Payer: Nomi Health Commercial |
$2,753.22
|
| Rate for Payer: PACE Medicare |
$871.85
|
| Rate for Payer: PACE SWMI |
$917.74
|
| Rate for Payer: PHP Medicare Advantage |
$917.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,967.88
|
| Rate for Payer: Priority Health Medicare |
$917.74
|
| Rate for Payer: Priority Health Tiered Network |
$2,374.30
|
| Rate for Payer: Railroad Medicare Medicare |
$917.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$917.74
|
| Rate for Payer: UHC Medicaid |
$479.98
|
| Rate for Payer: UHCCP Medicaid |
$479.98
|
| Rate for Payer: VA VA |
$917.74
|
|
|
ENDOCRINE DISORDERS WITH CC
|
Facility
|
IP
|
$17,158.06
|
|
|
Service Code
|
MSDRG 644
|
| Min. Negotiated Rate |
$8,075.41 |
| Max. Negotiated Rate |
$17,158.06 |
| Rate for Payer: Aetna Medicare |
$8,840.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,625.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,625.54
|
| Rate for Payer: BCBS MAPPO |
$8,500.43
|
| Rate for Payer: BCBS Trust/PPO |
$17,158.06
|
| Rate for Payer: BCN Commercial |
$17,158.06
|
| Rate for Payer: BCN Medicare Advantage |
$8,500.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,500.43
|
| Rate for Payer: Mclaren Medicare |
$8,500.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,925.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,775.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,350.47
|
| Rate for Payer: Nomi Health Commercial |
$13,222.50
|
| Rate for Payer: PACE Medicare |
$8,075.41
|
| Rate for Payer: PACE SWMI |
$8,500.43
|
| Rate for Payer: PHP Medicare Advantage |
$8,500.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,525.19
|
| Rate for Payer: Priority Health Medicare |
$8,500.43
|
| Rate for Payer: Priority Health Tiered Network |
$13,220.15
|
| Rate for Payer: Railroad Medicare Medicare |
$8,500.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,707.50
|
| Rate for Payer: UHC Core |
$13,977.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,500.43
|
| Rate for Payer: UHC Exchange |
$11,415.42
|
| Rate for Payer: VA VA |
$8,500.43
|
|
|
ENDOCRINE DISORDERS WITH MCC
|
Facility
|
IP
|
$26,831.43
|
|
|
Service Code
|
MSDRG 643
|
| Min. Negotiated Rate |
$12,635.41 |
| Max. Negotiated Rate |
$26,831.43 |
| Rate for Payer: Aetna Medicare |
$13,832.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,625.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,625.54
|
| Rate for Payer: BCBS MAPPO |
$13,300.43
|
| Rate for Payer: BCBS Trust/PPO |
$25,329.80
|
| Rate for Payer: BCN Commercial |
$25,329.80
|
| Rate for Payer: BCN Medicare Advantage |
$13,300.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,300.43
|
| Rate for Payer: Mclaren Medicare |
$13,300.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,965.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,295.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,630.47
|
| Rate for Payer: Nomi Health Commercial |
$21,234.69
|
| Rate for Payer: PACE Medicare |
$12,635.41
|
| Rate for Payer: PACE SWMI |
$13,300.43
|
| Rate for Payer: PHP Medicare Advantage |
$13,300.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,538.65
|
| Rate for Payer: Priority Health Medicare |
$13,300.43
|
| Rate for Payer: Priority Health Tiered Network |
$21,230.92
|
| Rate for Payer: Railroad Medicare Medicare |
$13,300.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,831.43
|
| Rate for Payer: UHC Core |
$22,447.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,300.43
|
| Rate for Payer: UHC Exchange |
$18,332.62
|
| Rate for Payer: VA VA |
$13,300.43
|
|
|
ENDOCRINE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,523.29
|
|
|
Service Code
|
MSDRG 645
|
| Min. Negotiated Rate |
$6,190.77 |
| Max. Negotiated Rate |
$12,523.29 |
| Rate for Payer: Aetna Medicare |
$6,777.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,145.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,145.75
|
| Rate for Payer: BCBS MAPPO |
$6,516.60
|
| Rate for Payer: BCBS Trust/PPO |
$9,880.52
|
| Rate for Payer: BCN Commercial |
$9,880.52
|
| Rate for Payer: BCN Medicare Advantage |
$6,516.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,516.60
|
| Rate for Payer: Mclaren Medicare |
$6,516.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,842.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,494.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,168.26
|
| Rate for Payer: Nomi Health Commercial |
$9,911.07
|
| Rate for Payer: PACE Medicare |
$6,190.77
|
| Rate for Payer: PACE SWMI |
$6,516.60
|
| Rate for Payer: PHP Medicare Advantage |
$6,516.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,386.64
|
| Rate for Payer: Priority Health Medicare |
$6,516.60
|
| Rate for Payer: Priority Health Tiered Network |
$9,909.31
|
| Rate for Payer: Railroad Medicare Medicare |
$6,516.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,523.29
|
| Rate for Payer: UHC Core |
$10,477.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,516.60
|
| Rate for Payer: UHC Exchange |
$8,556.56
|
| Rate for Payer: VA VA |
$6,516.60
|
|
|
ENDOMETRIAL ABLATION, THERMAL, WITHOUT HYSTEROSCOPIC GUIDANCE
|
Facility
|
OP
|
$16,119.31
|
|
|
Service Code
|
CPT 58353
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,606.87 |
| Max. Negotiated Rate |
$16,119.31 |
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: Aetna Medicare |
$5,183.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,651.35
|
| Rate for Payer: BCN Commercial |
$2,651.35
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Mclaren Medicaid |
$2,606.87
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$5,233.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Nomi Health Commercial |
$14,953.38
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,119.31
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health Tiered Network |
$12,895.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
ENDOSCOPIC EVALUATION OF SMALL INTESTINAL POUCH (EG, KOCK POUCH, ILEAL RESERVOIR [S OR J]); WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$2,996.60
|
|
|
Service Code
|
CPT 44386
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$484.62 |
| Max. Negotiated Rate |
$2,996.60 |
| Rate for Payer: Aetna Medicare |
$963.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,158.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,158.26
|
| Rate for Payer: BCBS Complete |
$508.89
|
| Rate for Payer: BCBS MAPPO |
$926.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,158.95
|
| Rate for Payer: BCN Commercial |
$1,158.95
|
| Rate for Payer: BCN Medicare Advantage |
$926.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.61
|
| Rate for Payer: Mclaren Medicaid |
$484.62
|
| Rate for Payer: Mclaren Medicare |
$926.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.94
|
| Rate for Payer: Meridian Medicaid |
$972.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,019.27
|
| Rate for Payer: Nomi Health Commercial |
$2,779.83
|
| Rate for Payer: PACE Medicare |
$880.28
|
| Rate for Payer: PACE SWMI |
$926.61
|
| Rate for Payer: PHP Medicare Advantage |
$926.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,996.60
|
| Rate for Payer: Priority Health Medicare |
$926.61
|
| Rate for Payer: Priority Health Tiered Network |
$2,397.28
|
| Rate for Payer: Railroad Medicare Medicare |
$926.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$926.61
|
| Rate for Payer: UHC Medicaid |
$484.62
|
| Rate for Payer: UHCCP Medicaid |
$484.62
|
| Rate for Payer: VA VA |
$926.61
|
|
|
ENDOSCOPIC MARKER
|
Facility
|
IP
|
$77.70
|
|
|
Service Code
|
NDC 09900000099
|
| Hospital Charge Code |
2138700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.95 |
| Max. Negotiated Rate |
$69.93 |
| Rate for Payer: Aetna Commercial |
$66.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.51
|
| Rate for Payer: Cash Price |
$62.16
|
| Rate for Payer: Cofinity Advantage |
$54.39
|
| Rate for Payer: Cofinity Commercial |
$66.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.16
|
| Rate for Payer: Healthscope Commercial |
$69.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.27
|
| Rate for Payer: PHP Commercial |
$66.05
|
| Rate for Payer: Priority Health SBD |
$48.95
|
|
|
ENDOSCOPIC MARKER
|
Facility
|
OP
|
$77.70
|
|
|
Service Code
|
NDC 09900000099
|
| Hospital Charge Code |
2138700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.54 |
| Max. Negotiated Rate |
$69.93 |
| Rate for Payer: Aetna Commercial |
$66.05
|
| Rate for Payer: Aetna Medicare |
$38.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.51
|
| Rate for Payer: BCBS Complete |
$31.08
|
| Rate for Payer: Cash Price |
$62.16
|
| Rate for Payer: Cofinity Advantage |
$54.39
|
| Rate for Payer: Cofinity Commercial |
$66.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.16
|
| Rate for Payer: Healthscope Commercial |
$69.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.27
|
| Rate for Payer: PHP Commercial |
$66.05
|
| Rate for Payer: Priority Health SBD |
$48.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.51
|
| Rate for Payer: UHC Core |
$40.48
|
| Rate for Payer: UHC Exchange |
$30.54
|
|
|
ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES
|
Facility
|
IP
|
$93,022.47
|
|
|
Service Code
|
MSDRG 213
|
| Min. Negotiated Rate |
$42,449.06 |
| Max. Negotiated Rate |
$93,022.47 |
| Rate for Payer: Aetna Medicare |
$46,470.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55,854.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55,854.03
|
| Rate for Payer: BCBS MAPPO |
$44,683.22
|
| Rate for Payer: BCBS Trust/PPO |
$91,330.99
|
| Rate for Payer: BCN Commercial |
$91,330.99
|
| Rate for Payer: BCN Medicare Advantage |
$44,683.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44,683.22
|
| Rate for Payer: Mclaren Medicare |
$44,683.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46,917.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51,385.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$49,151.54
|
| Rate for Payer: Nomi Health Commercial |
$73,619.01
|
| Rate for Payer: PACE Medicare |
$42,449.06
|
| Rate for Payer: PACE SWMI |
$44,683.22
|
| Rate for Payer: PHP Medicare Advantage |
$44,683.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$92,007.44
|
| Rate for Payer: Priority Health Medicare |
$44,683.22
|
| Rate for Payer: Priority Health Tiered Network |
$73,605.94
|
| Rate for Payer: Railroad Medicare Medicare |
$44,683.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93,022.47
|
| Rate for Payer: UHC Core |
$77,825.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44,683.22
|
| Rate for Payer: UHC Exchange |
$63,557.75
|
| Rate for Payer: VA VA |
$44,683.22
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC
|
Facility
|
IP
|
$115,485.71
|
|
|
Service Code
|
MSDRG 266
|
| Min. Negotiated Rate |
$45,543.64 |
| Max. Negotiated Rate |
$115,485.71 |
| Rate for Payer: Aetna Medicare |
$49,858.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59,925.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59,925.84
|
| Rate for Payer: BCBS MAPPO |
$47,940.67
|
| Rate for Payer: BCBS Trust/PPO |
$115,485.71
|
| Rate for Payer: BCN Commercial |
$115,485.71
|
| Rate for Payer: BCN Medicare Advantage |
$47,940.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47,940.67
|
| Rate for Payer: Mclaren Medicare |
$47,940.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50,337.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55,131.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$52,734.74
|
| Rate for Payer: Nomi Health Commercial |
$79,056.36
|
| Rate for Payer: PACE Medicare |
$45,543.64
|
| Rate for Payer: PACE SWMI |
$47,940.67
|
| Rate for Payer: PHP Medicare Advantage |
$47,940.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$98,802.92
|
| Rate for Payer: Priority Health Medicare |
$47,940.67
|
| Rate for Payer: Priority Health Tiered Network |
$79,042.33
|
| Rate for Payer: Railroad Medicare Medicare |
$47,940.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99,892.92
|
| Rate for Payer: UHC Core |
$83,572.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$47,940.67
|
| Rate for Payer: UHC Exchange |
$68,251.99
|
| Rate for Payer: VA VA |
$47,940.67
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$96,918.48
|
|
|
Service Code
|
MSDRG 267
|
| Min. Negotiated Rate |
$35,502.97 |
| Max. Negotiated Rate |
$96,918.48 |
| Rate for Payer: Aetna Medicare |
$38,866.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46,714.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46,714.44
|
| Rate for Payer: BCBS MAPPO |
$37,371.55
|
| Rate for Payer: BCBS Trust/PPO |
$96,918.48
|
| Rate for Payer: BCN Commercial |
$96,918.48
|
| Rate for Payer: BCN Medicare Advantage |
$37,371.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37,371.55
|
| Rate for Payer: Mclaren Medicare |
$37,371.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39,240.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42,977.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$41,108.71
|
| Rate for Payer: Nomi Health Commercial |
$61,414.32
|
| Rate for Payer: PACE Medicare |
$35,502.97
|
| Rate for Payer: PACE SWMI |
$37,371.55
|
| Rate for Payer: PHP Medicare Advantage |
$37,371.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$76,754.28
|
| Rate for Payer: Priority Health Medicare |
$37,371.55
|
| Rate for Payer: Priority Health Tiered Network |
$61,403.42
|
| Rate for Payer: Railroad Medicare Medicare |
$37,371.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77,601.04
|
| Rate for Payer: UHC Core |
$64,923.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37,371.55
|
| Rate for Payer: UHC Exchange |
$53,021.03
|
| Rate for Payer: VA VA |
$37,371.55
|
|
|
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, RADIOFREQUENCY; FIRST VEIN TREATED
|
Facility
|
OP
|
$10,174.29
|
|
|
Service Code
|
CPT 36475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,015.63
|
| Rate for Payer: BCN Commercial |
$2,015.63
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, RADIOFREQUENCY; SUBSEQUENT VEIN(S) TREATED IN A SINGLE EXTREMITY, EACH THROUGH SEPARATE ACCESS SITES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$779.26
|
|
|
Service Code
|
CPT 36476
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$779.26 |
| Max. Negotiated Rate |
$779.26 |
| Rate for Payer: BCBS Trust/PPO |
$779.26
|
| Rate for Payer: BCN Commercial |
$779.26
|
|
|
ENFORTUMAB VEDOTIN-EJFV 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,612.41
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
192400
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,945.82 |
| Max. Negotiated Rate |
$11,351.17 |
| Rate for Payer: Aetna Commercial |
$10,720.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,198.07
|
| Rate for Payer: Cash Price |
$10,089.93
|
| Rate for Payer: Cofinity Advantage |
$8,828.69
|
| Rate for Payer: Cofinity Commercial |
$10,846.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,089.93
|
| Rate for Payer: Healthscope Commercial |
$11,351.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,720.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,459.31
|
| Rate for Payer: PHP Commercial |
$10,720.55
|
| Rate for Payer: Priority Health SBD |
$7,945.82
|
|
|
ENFORTUMAB VEDOTIN-EJFV 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12,612.41
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
192400
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$11,351.17 |
| Rate for Payer: Aetna Commercial |
$10,720.55
|
| Rate for Payer: Aetna Medicare |
$38.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,198.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.89
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$36.71
|
| Rate for Payer: BCBS Trust/PPO |
$92.12
|
| Rate for Payer: BCN Commercial |
$92.12
|
| Rate for Payer: BCN Medicare Advantage |
$36.71
|
| Rate for Payer: Cash Price |
$10,089.93
|
| Rate for Payer: Cash Price |
$10,089.93
|
| Rate for Payer: Cofinity Advantage |
$8,828.69
|
| Rate for Payer: Cofinity Commercial |
$10,846.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,089.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.71
|
| Rate for Payer: Healthscope Commercial |
$11,351.17
|
| Rate for Payer: Mclaren Medicaid |
$19.20
|
| Rate for Payer: Mclaren Medicare |
$36.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.55
|
| Rate for Payer: Meridian Medicaid |
$38.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,720.55
|
| Rate for Payer: Nomi Health Commercial |
$110.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,459.31
|
| Rate for Payer: PACE Medicare |
$34.87
|
| Rate for Payer: PACE SWMI |
$36.71
|
| Rate for Payer: PHP Commercial |
$10,720.55
|
| Rate for Payer: PHP Medicare Advantage |
$36.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$115.88
|
| Rate for Payer: Priority Health Medicare |
$36.71
|
| Rate for Payer: Priority Health SBD |
$7,945.82
|
| Rate for Payer: Priority Health Tiered Network |
$92.70
|
| Rate for Payer: Railroad Medicare Medicare |
$36.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.59
|
| Rate for Payer: UHC Core |
$60.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$36.71
|
| Rate for Payer: UHC Exchange |
$60.59
|
| Rate for Payer: UHC Medicaid |
$19.20
|
| Rate for Payer: UHCCP Medicaid |
$19.20
|
| Rate for Payer: VA VA |
$36.71
|
|
