|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$669.09
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$421.53 |
| Max. Negotiated Rate |
$602.18 |
| Rate for Payer: Aetna Commercial |
$568.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.91
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cofinity Commercial |
$468.36
|
| Rate for Payer: Cofinity Commercial |
$575.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$468.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.27
|
| Rate for Payer: Healthscope Commercial |
$602.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.73
|
| Rate for Payer: PHP Commercial |
$568.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.91
|
| Rate for Payer: Priority Health SBD |
$421.53
|
|
|
DARBEPOETIN ALFA 300 MCG/0.6 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$5,880.40
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$5,292.36 |
| Rate for Payer: Aetna Commercial |
$4,998.34
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,822.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$4,704.32
|
| Rate for Payer: Cash Price |
$4,704.32
|
| Rate for Payer: Cofinity Commercial |
$5,057.14
|
| Rate for Payer: Cofinity Commercial |
$4,116.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,116.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,704.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$5,292.36
|
| Rate for Payer: Mclaren Medicaid |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,998.34
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$4,998.34
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,822.26
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health SBD |
$3,704.65
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$2.93
|
| Rate for Payer: UHCCP Medicaid |
$1.65
|
| Rate for Payer: VA VA |
$2.93
|
|
|
DARBEPOETIN ALFA 300 MCG/0.6 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$5,880.40
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,704.65 |
| Max. Negotiated Rate |
$5,292.36 |
| Rate for Payer: Aetna Commercial |
$4,998.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,822.26
|
| Rate for Payer: Cash Price |
$4,704.32
|
| Rate for Payer: Cofinity Commercial |
$4,116.28
|
| Rate for Payer: Cofinity Commercial |
$5,057.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,116.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,704.32
|
| Rate for Payer: Healthscope Commercial |
$5,292.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,998.34
|
| Rate for Payer: PHP Commercial |
$4,998.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,822.26
|
| Rate for Payer: Priority Health SBD |
$3,704.65
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$964.99
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76965
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$607.94 |
| Max. Negotiated Rate |
$868.49 |
| Rate for Payer: Aetna Commercial |
$820.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.24
|
| Rate for Payer: Cash Price |
$771.99
|
| Rate for Payer: Cofinity Commercial |
$675.49
|
| Rate for Payer: Cofinity Commercial |
$829.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$675.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.99
|
| Rate for Payer: Healthscope Commercial |
$868.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.24
|
| Rate for Payer: PHP Commercial |
$820.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.24
|
| Rate for Payer: Priority Health SBD |
$607.94
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$964.99
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76965
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$868.49 |
| Rate for Payer: Aetna Commercial |
$820.24
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$771.99
|
| Rate for Payer: Cash Price |
$771.99
|
| Rate for Payer: Cofinity Commercial |
$829.89
|
| Rate for Payer: Cofinity Commercial |
$675.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$675.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$868.49
|
| Rate for Payer: Mclaren Medicaid |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.24
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$820.24
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.24
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health SBD |
$607.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$2.93
|
| Rate for Payer: UHCCP Medicaid |
$1.65
|
| Rate for Payer: VA VA |
$2.93
|
|
|
DARBEPOETIN ALFA 40 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
OP
|
$964.99
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$868.49 |
| Rate for Payer: Aetna Commercial |
$820.24
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$771.99
|
| Rate for Payer: Cash Price |
$771.99
|
| Rate for Payer: Cofinity Commercial |
$675.49
|
| Rate for Payer: Cofinity Commercial |
$829.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$675.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$868.49
|
| Rate for Payer: Mclaren Medicaid |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.24
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$820.24
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.24
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health SBD |
$607.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$2.93
|
| Rate for Payer: UHCCP Medicaid |
$1.65
|
| Rate for Payer: VA VA |
$2.93
|
|
|
DARBEPOETIN ALFA 500 MCG/ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$9,800.65
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,174.41 |
| Max. Negotiated Rate |
$8,820.58 |
| Rate for Payer: Aetna Commercial |
$8,330.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,370.42
|
| Rate for Payer: Cash Price |
$7,840.52
|
| Rate for Payer: Cofinity Commercial |
$6,860.45
|
| Rate for Payer: Cofinity Commercial |
$8,428.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,860.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,840.52
|
| Rate for Payer: Healthscope Commercial |
$8,820.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,330.55
|
| Rate for Payer: PHP Commercial |
$8,330.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,370.42
|
| Rate for Payer: Priority Health SBD |
$6,174.41
|
|
|
DARBEPOETIN ALFA 500 MCG/ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$9,800.65
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$8,820.58 |
| Rate for Payer: Aetna Commercial |
$8,330.55
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,370.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$7,840.52
|
| Rate for Payer: Cash Price |
$7,840.52
|
| Rate for Payer: Cofinity Commercial |
$8,428.56
|
| Rate for Payer: Cofinity Commercial |
$6,860.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,860.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,840.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$8,820.58
|
| Rate for Payer: Mclaren Medicaid |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,330.55
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$8,330.55
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,370.42
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health SBD |
$6,174.41
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$2.93
|
| Rate for Payer: UHCCP Medicaid |
$1.65
|
| Rate for Payer: VA VA |
$2.93
|
|
|
DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$1,447.49
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$911.92 |
| Max. Negotiated Rate |
$1,302.74 |
| Rate for Payer: Aetna Commercial |
$1,230.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.87
|
| Rate for Payer: Cash Price |
$1,157.99
|
| Rate for Payer: Cofinity Commercial |
$1,013.24
|
| Rate for Payer: Cofinity Commercial |
$1,244.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,013.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,157.99
|
| Rate for Payer: Healthscope Commercial |
$1,302.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.37
|
| Rate for Payer: PHP Commercial |
$1,230.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.87
|
| Rate for Payer: Priority Health SBD |
$911.92
|
|
|
DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$1,447.49
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$1,302.74 |
| Rate for Payer: Aetna Commercial |
$1,230.37
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$1,157.99
|
| Rate for Payer: Cash Price |
$1,157.99
|
| Rate for Payer: Cofinity Commercial |
$1,244.84
|
| Rate for Payer: Cofinity Commercial |
$1,013.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,013.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,157.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$1,302.74
|
| Rate for Payer: Mclaren Medicaid |
$1.57
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.37
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$1,230.37
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.87
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health SBD |
$911.92
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$2.93
|
| Rate for Payer: UHCCP Medicaid |
$1.65
|
| Rate for Payer: VA VA |
$2.93
|
|
|
DARUNAVIR 800 MG-COBICISTAT 150 MG TABLET
|
Facility
|
IP
|
$8,898.65
|
|
|
Service Code
|
NDC 59676057530
|
| Hospital Charge Code |
173955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5,606.15 |
| Max. Negotiated Rate |
$8,008.78 |
| Rate for Payer: Aetna Commercial |
$7,563.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,784.12
|
| Rate for Payer: Cash Price |
$7,118.92
|
| Rate for Payer: Cofinity Commercial |
$6,229.06
|
| Rate for Payer: Cofinity Commercial |
$7,652.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,229.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,118.92
|
| Rate for Payer: Healthscope Commercial |
$8,008.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,563.85
|
| Rate for Payer: PHP Commercial |
$7,563.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,784.12
|
| Rate for Payer: Priority Health SBD |
$5,606.15
|
|
|
DARUNAVIR 800 MG-COBICISTAT 150 MG TABLET
|
Facility
|
OP
|
$8,898.65
|
|
|
Service Code
|
NDC 59676057530
|
| Hospital Charge Code |
173955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,559.46 |
| Max. Negotiated Rate |
$8,008.78 |
| Rate for Payer: Aetna Commercial |
$7,563.85
|
| Rate for Payer: Aetna Medicare |
$4,449.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,784.12
|
| Rate for Payer: BCBS Complete |
$3,559.46
|
| Rate for Payer: Cash Price |
$7,118.92
|
| Rate for Payer: Cofinity Commercial |
$6,229.06
|
| Rate for Payer: Cofinity Commercial |
$7,652.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,229.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,118.92
|
| Rate for Payer: Healthscope Commercial |
$8,008.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,563.85
|
| Rate for Payer: PHP Commercial |
$7,563.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,784.12
|
| Rate for Payer: Priority Health SBD |
$5,606.15
|
|
|
DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,153.96
|
|
|
Service Code
|
HCPCS J9150
|
| Hospital Charge Code |
22661
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$726.99 |
| Max. Negotiated Rate |
$1,038.56 |
| Rate for Payer: Aetna Commercial |
$980.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.07
|
| Rate for Payer: Cash Price |
$923.17
|
| Rate for Payer: Cofinity Commercial |
$807.77
|
| Rate for Payer: Cofinity Commercial |
$992.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$807.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$923.17
|
| Rate for Payer: Healthscope Commercial |
$1,038.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$980.87
|
| Rate for Payer: PHP Commercial |
$980.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.07
|
| Rate for Payer: Priority Health SBD |
$726.99
|
|
|
DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,153.96
|
|
|
Service Code
|
HCPCS J9150
|
| Hospital Charge Code |
22661
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$1,038.56 |
| Rate for Payer: Aetna Commercial |
$980.87
|
| Rate for Payer: Aetna Medicare |
$22.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.12
|
| Rate for Payer: BCBS Complete |
$12.21
|
| Rate for Payer: BCBS MAPPO |
$21.70
|
| Rate for Payer: BCN Medicare Advantage |
$21.70
|
| Rate for Payer: Cash Price |
$923.17
|
| Rate for Payer: Cash Price |
$923.17
|
| Rate for Payer: Cofinity Commercial |
$992.41
|
| Rate for Payer: Cofinity Commercial |
$807.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$807.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$923.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.70
|
| Rate for Payer: Healthscope Commercial |
$1,038.56
|
| Rate for Payer: Mclaren Medicaid |
$11.63
|
| Rate for Payer: Mclaren Medicare |
$21.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.79
|
| Rate for Payer: Meridian Medicaid |
$12.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$980.87
|
| Rate for Payer: PACE Medicare |
$20.61
|
| Rate for Payer: PACE SWMI |
$21.70
|
| Rate for Payer: PHP Commercial |
$980.87
|
| Rate for Payer: PHP Medicare Advantage |
$21.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.07
|
| Rate for Payer: Priority Health Medicare |
$21.70
|
| Rate for Payer: Priority Health SBD |
$726.99
|
| Rate for Payer: Railroad Medicare Medicare |
$21.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.70
|
| Rate for Payer: UHC Medicare Advantage |
$21.70
|
| Rate for Payer: UHCCP Medicaid |
$12.22
|
| Rate for Payer: VA VA |
$21.70
|
|
|
DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$4,448.08
|
|
|
Service Code
|
CPT 11044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$889.65
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
DEBRIDEMENT (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), OPEN WOUND, (EG, FIBRIN, DEVITALIZED EPIDERMIS AND/OR DERMIS, EXUDATE, DEBRIS, BIOFILM), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, USE OF A WHIRLPOOL, WHEN PERFORMED AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION, TOTAL WOUND(S) SURFACE AREA; FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$545.50
|
|
|
Service Code
|
CPT 97597
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN AND SUBCUTANEOUS TISSUES
|
Facility
|
OP
|
$1,931.58
|
|
|
Service Code
|
CPT 11010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$386.33
|
| Rate for Payer: VA VA |
$686.20
|
|
|
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN, SUBCUTANEOUS TISSUE, MUSCLE FASCIA, AND MUSCLE
|
Facility
|
OP
|
$1,931.58
|
|
|
Service Code
|
CPT 11011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$386.33
|
| Rate for Payer: VA VA |
$686.20
|
|
|
DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,680.50
|
|
|
Service Code
|
CPT 11043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$319.99 |
| Max. Negotiated Rate |
$1,680.50 |
| Rate for Payer: Aetna Medicare |
$620.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$336.11
|
| Rate for Payer: VA VA |
$597.00
|
|
|
DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE
|
Facility
|
OP
|
$1,680.50
|
|
|
Service Code
|
CPT 11000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$319.99 |
| Max. Negotiated Rate |
$1,680.50 |
| Rate for Payer: Aetna Medicare |
$620.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$336.11
|
| Rate for Payer: VA VA |
$597.00
|
|
|
DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,096.83
|
|
|
Service Code
|
CPT 11042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$219.37
|
| Rate for Payer: VA VA |
$389.65
|
|
|
DECITABINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$371.77
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
76364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$234.22 |
| Max. Negotiated Rate |
$334.59 |
| Rate for Payer: Aetna Commercial |
$316.00
|
| Rate for Payer: Aetna Commercial |
$335.44
|
| Rate for Payer: Aetna Commercial |
$471.12
|
| Rate for Payer: Aetna Commercial |
$425.20
|
| Rate for Payer: Aetna Commercial |
$844.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.27
|
| Rate for Payer: Cash Price |
$443.41
|
| Rate for Payer: Cash Price |
$315.70
|
| Rate for Payer: Cash Price |
$297.42
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cash Price |
$795.14
|
| Rate for Payer: Cofinity Commercial |
$276.24
|
| Rate for Payer: Cofinity Commercial |
$260.24
|
| Rate for Payer: Cofinity Commercial |
$319.72
|
| Rate for Payer: Cofinity Commercial |
$430.21
|
| Rate for Payer: Cofinity Commercial |
$339.38
|
| Rate for Payer: Cofinity Commercial |
$350.17
|
| Rate for Payer: Cofinity Commercial |
$476.66
|
| Rate for Payer: Cofinity Commercial |
$387.98
|
| Rate for Payer: Cofinity Commercial |
$695.74
|
| Rate for Payer: Cofinity Commercial |
$854.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$695.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$276.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$350.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$387.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.41
|
| Rate for Payer: Healthscope Commercial |
$894.53
|
| Rate for Payer: Healthscope Commercial |
$334.59
|
| Rate for Payer: Healthscope Commercial |
$355.17
|
| Rate for Payer: Healthscope Commercial |
$450.22
|
| Rate for Payer: Healthscope Commercial |
$498.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$844.83
|
| Rate for Payer: PHP Commercial |
$471.12
|
| Rate for Payer: PHP Commercial |
$316.00
|
| Rate for Payer: PHP Commercial |
$335.44
|
| Rate for Payer: PHP Commercial |
$425.20
|
| Rate for Payer: PHP Commercial |
$844.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.05
|
| Rate for Payer: Priority Health SBD |
$626.17
|
| Rate for Payer: Priority Health SBD |
$248.62
|
| Rate for Payer: Priority Health SBD |
$315.15
|
| Rate for Payer: Priority Health SBD |
$234.22
|
| Rate for Payer: Priority Health SBD |
$349.18
|
|
|
DECITABINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$371.77
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
76364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$148.71 |
| Max. Negotiated Rate |
$334.59 |
| Rate for Payer: Aetna Commercial |
$316.00
|
| Rate for Payer: Aetna Commercial |
$335.44
|
| Rate for Payer: Aetna Commercial |
$425.20
|
| Rate for Payer: Aetna Commercial |
$471.12
|
| Rate for Payer: Aetna Commercial |
$844.83
|
| Rate for Payer: Aetna Commercial |
$5,644.60
|
| Rate for Payer: Aetna Commercial |
$6,685.14
|
| Rate for Payer: Aetna Medicare |
$277.13
|
| Rate for Payer: Aetna Medicare |
$250.12
|
| Rate for Payer: Aetna Medicare |
$496.96
|
| Rate for Payer: Aetna Medicare |
$3,320.36
|
| Rate for Payer: Aetna Medicare |
$197.31
|
| Rate for Payer: Aetna Medicare |
$185.88
|
| Rate for Payer: Aetna Medicare |
$3,932.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,112.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,316.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.65
|
| Rate for Payer: BCBS Complete |
$3,145.95
|
| Rate for Payer: BCBS Complete |
$157.85
|
| Rate for Payer: BCBS Complete |
$221.70
|
| Rate for Payer: BCBS Complete |
$200.10
|
| Rate for Payer: BCBS Complete |
$148.71
|
| Rate for Payer: BCBS Complete |
$2,656.28
|
| Rate for Payer: BCBS Complete |
$397.57
|
| Rate for Payer: Cash Price |
$443.41
|
| Rate for Payer: Cash Price |
$795.14
|
| Rate for Payer: Cash Price |
$297.42
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cash Price |
$5,312.57
|
| Rate for Payer: Cash Price |
$315.70
|
| Rate for Payer: Cash Price |
$6,291.90
|
| Rate for Payer: Cofinity Commercial |
$350.17
|
| Rate for Payer: Cofinity Commercial |
$430.21
|
| Rate for Payer: Cofinity Commercial |
$387.98
|
| Rate for Payer: Cofinity Commercial |
$319.72
|
| Rate for Payer: Cofinity Commercial |
$854.77
|
| Rate for Payer: Cofinity Commercial |
$695.74
|
| Rate for Payer: Cofinity Commercial |
$6,763.79
|
| Rate for Payer: Cofinity Commercial |
$5,505.41
|
| Rate for Payer: Cofinity Commercial |
$476.66
|
| Rate for Payer: Cofinity Commercial |
$260.24
|
| Rate for Payer: Cofinity Commercial |
$4,648.50
|
| Rate for Payer: Cofinity Commercial |
$5,711.01
|
| Rate for Payer: Cofinity Commercial |
$339.38
|
| Rate for Payer: Cofinity Commercial |
$276.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$276.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$350.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$387.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,648.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,505.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$695.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,312.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,291.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.42
|
| Rate for Payer: Healthscope Commercial |
$498.83
|
| Rate for Payer: Healthscope Commercial |
$334.59
|
| Rate for Payer: Healthscope Commercial |
$355.17
|
| Rate for Payer: Healthscope Commercial |
$5,976.64
|
| Rate for Payer: Healthscope Commercial |
$7,078.38
|
| Rate for Payer: Healthscope Commercial |
$450.22
|
| Rate for Payer: Healthscope Commercial |
$894.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,644.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,685.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$844.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.12
|
| Rate for Payer: PHP Commercial |
$316.00
|
| Rate for Payer: PHP Commercial |
$5,644.60
|
| Rate for Payer: PHP Commercial |
$425.20
|
| Rate for Payer: PHP Commercial |
$6,685.14
|
| Rate for Payer: PHP Commercial |
$844.83
|
| Rate for Payer: PHP Commercial |
$335.44
|
| Rate for Payer: PHP Commercial |
$471.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,112.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,316.46
|
| Rate for Payer: Priority Health SBD |
$4,954.87
|
| Rate for Payer: Priority Health SBD |
$315.15
|
| Rate for Payer: Priority Health SBD |
$626.17
|
| Rate for Payer: Priority Health SBD |
$349.18
|
| Rate for Payer: Priority Health SBD |
$248.62
|
| Rate for Payer: Priority Health SBD |
$234.22
|
| Rate for Payer: Priority Health SBD |
$4,183.65
|
|
|
DECLOTTING BY THROMBOLYTIC AGENT OF IMPLANTED VASCULAR ACCESS DEVICE OR CATHETER
|
Facility
|
OP
|
$910.59
|
|
|
Service Code
|
CPT 36593
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$173.39 |
| Max. Negotiated Rate |
$910.59 |
| Rate for Payer: Aetna Medicare |
$336.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$404.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$404.36
|
| Rate for Payer: BCBS Complete |
$182.06
|
| Rate for Payer: BCBS MAPPO |
$323.49
|
| Rate for Payer: BCN Medicare Advantage |
$323.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$323.49
|
| Rate for Payer: Mclaren Medicaid |
$173.39
|
| Rate for Payer: Mclaren Medicare |
$323.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$339.66
|
| Rate for Payer: Meridian Medicaid |
$182.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.01
|
| Rate for Payer: PACE Medicare |
$307.32
|
| Rate for Payer: PACE SWMI |
$323.49
|
| Rate for Payer: PHP Medicare Advantage |
$323.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.39
|
| Rate for Payer: Priority Health Medicare |
$323.49
|
| Rate for Payer: Railroad Medicare Medicare |
$323.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$910.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$323.49
|
| Rate for Payer: UHC Medicare Advantage |
$323.49
|
| Rate for Payer: UHCCP Medicaid |
$182.12
|
| Rate for Payer: VA VA |
$323.49
|
|
|
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 Commercial |
$105.45
|
| Rate for Payer: Cofinity Commercial |
$129.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.45
|
| 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: PHP Commercial |
$128.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.92
|
| Rate for Payer: Priority Health SBD |
$94.91
|
|
