|
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 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$669.09
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$602.18 |
| Rate for Payer: Aetna Commercial |
$568.73
|
| Rate for Payer: Aetna Medicare |
$3.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$8.40
|
| Rate for Payer: BCN Commercial |
$8.40
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cofinity Commercial |
$575.42
|
| Rate for Payer: Cofinity Commercial |
$468.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$468.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$602.18
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.73
|
| Rate for Payer: Nomi Health Commercial |
$8.91
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$568.73
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.73
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$6.98
|
| Rate for Payer: Priority Health SBD |
$421.53
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.67
|
| Rate for Payer: VA VA |
$2.97
|
|
|
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 |
$1.59 |
| Max. Negotiated Rate |
$5,292.36 |
| Rate for Payer: Aetna Commercial |
$4,998.34
|
| Rate for Payer: Aetna Medicare |
$3.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,822.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$8.40
|
| Rate for Payer: BCN Commercial |
$8.40
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| 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 |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$5,292.36
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,998.34
|
| Rate for Payer: Nomi Health Commercial |
$8.91
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$4,998.34
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,822.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.73
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$6.98
|
| Rate for Payer: Priority Health SBD |
$3,704.65
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.67
|
| Rate for Payer: VA VA |
$2.97
|
|
|
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 |
$1.59 |
| Max. Negotiated Rate |
$868.49 |
| Rate for Payer: Aetna Commercial |
$820.24
|
| Rate for Payer: Aetna Medicare |
$3.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$8.40
|
| Rate for Payer: BCN Commercial |
$8.40
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| 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 |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$868.49
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.24
|
| Rate for Payer: Nomi Health Commercial |
$8.91
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$820.24
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.73
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$6.98
|
| Rate for Payer: Priority Health SBD |
$607.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.67
|
| Rate for Payer: VA VA |
$2.97
|
|
|
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 |
$1.59 |
| Max. Negotiated Rate |
$868.49 |
| Rate for Payer: Aetna Commercial |
$820.24
|
| Rate for Payer: Aetna Medicare |
$3.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$8.40
|
| Rate for Payer: BCN Commercial |
$8.40
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| 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 |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$868.49
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.24
|
| Rate for Payer: Nomi Health Commercial |
$8.91
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$820.24
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.73
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$6.98
|
| Rate for Payer: Priority Health SBD |
$607.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.67
|
| Rate for Payer: VA VA |
$2.97
|
|
|
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 |
$1.59 |
| Max. Negotiated Rate |
$8,820.58 |
| Rate for Payer: Aetna Commercial |
$8,330.55
|
| Rate for Payer: Aetna Medicare |
$3.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,370.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$8.40
|
| Rate for Payer: BCN Commercial |
$8.40
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| 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 |
$6,860.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,860.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,840.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$8,820.58
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,330.55
|
| Rate for Payer: Nomi Health Commercial |
$8.91
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$8,330.55
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,370.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.73
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$6.98
|
| Rate for Payer: Priority Health SBD |
$6,174.41
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.67
|
| Rate for Payer: VA VA |
$2.97
|
|
|
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 |
$6,860.46
|
| Rate for Payer: Cofinity Commercial |
$8,428.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,860.46
|
| 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 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 |
$1.59 |
| Max. Negotiated Rate |
$1,302.74 |
| Rate for Payer: Aetna Commercial |
$1,230.37
|
| Rate for Payer: Aetna Medicare |
$3.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.71
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$8.40
|
| Rate for Payer: BCN Commercial |
$8.40
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| 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 |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$1,302.74
|
| Rate for Payer: Mclaren Medicaid |
$1.59
|
| Rate for Payer: Mclaren Medicare |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.37
|
| Rate for Payer: Nomi Health Commercial |
$8.91
|
| Rate for Payer: PACE Medicare |
$2.82
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PHP Commercial |
$1,230.37
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.73
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$6.98
|
| Rate for Payer: Priority Health SBD |
$911.92
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$1.67
|
| Rate for Payer: VA VA |
$2.97
|
|
|
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 |
$12.61 |
| Max. Negotiated Rate |
$1,038.56 |
| Rate for Payer: Aetna Commercial |
$980.87
|
| Rate for Payer: Aetna Medicare |
$24.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.40
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS MAPPO |
$23.52
|
| Rate for Payer: BCBS Trust/PPO |
$69.01
|
| Rate for Payer: BCN Commercial |
$69.01
|
| Rate for Payer: BCN Medicare Advantage |
$23.52
|
| 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 |
$23.52
|
| Rate for Payer: Healthscope Commercial |
$1,038.56
|
| Rate for Payer: Mclaren Medicaid |
$12.61
|
| Rate for Payer: Mclaren Medicare |
$23.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.70
|
| Rate for Payer: Meridian Medicaid |
$13.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$980.87
|
| Rate for Payer: Nomi Health Commercial |
$70.56
|
| Rate for Payer: PACE Medicare |
$22.34
|
| Rate for Payer: PACE SWMI |
$23.52
|
| Rate for Payer: PHP Commercial |
$980.87
|
| Rate for Payer: PHP Medicare Advantage |
$23.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.32
|
| Rate for Payer: Priority Health Medicare |
$23.52
|
| Rate for Payer: Priority Health Narrow Network |
$56.26
|
| Rate for Payer: Priority Health SBD |
$726.99
|
| Rate for Payer: Railroad Medicare Medicare |
$23.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.52
|
| Rate for Payer: UHC Medicare Advantage |
$23.52
|
| Rate for Payer: UHCCP Medicaid |
$13.24
|
| Rate for Payer: VA VA |
$23.52
|
|
|
DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 11047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.58 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: BCBS Trust/PPO |
$257.42
|
| Rate for Payer: BCN Commercial |
$257.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.58
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$4,989.41
|
|
|
Service Code
|
CPT 11044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$239.88 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$831.57
|
| Rate for Payer: BCN Commercial |
$831.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.88
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
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
|
$940.00
|
|
|
Service Code
|
CPT 97597
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$95.24
|
| Rate for Payer: BCN Commercial |
$95.24
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Nomi Health Commercial |
$408.83
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.49
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$109.60
|
| Rate for Payer: VA VA |
$194.68
|
|
|
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
|
$2,166.65
|
|
|
Service Code
|
CPT 11010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$291.44 |
| Max. Negotiated Rate |
$2,166.65 |
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$352.94
|
| Rate for Payer: BCN Commercial |
$352.94
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Nomi Health Commercial |
$1,447.66
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,166.65
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,733.32
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.44
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$388.11
|
| Rate for Payer: VA VA |
$689.36
|
|
|
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
|
$2,166.65
|
|
|
Service Code
|
CPT 11011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$260.41 |
| Max. Negotiated Rate |
$2,166.65 |
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$260.41
|
| Rate for Payer: BCN Commercial |
$260.41
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Nomi Health Commercial |
$1,447.66
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,166.65
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,733.32
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.37
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$388.11
|
| Rate for Payer: VA VA |
$689.36
|
|
|
DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 11046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$58.58 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: BCBS Trust/PPO |
$151.55
|
| Rate for Payer: BCN Commercial |
$151.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.58
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,885.01
|
|
|
Service Code
|
CPT 11043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$162.71 |
| Max. Negotiated Rate |
$1,885.01 |
| Rate for Payer: Aetna Medicare |
$623.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$749.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$749.69
|
| Rate for Payer: BCBS Complete |
$337.54
|
| Rate for Payer: BCBS MAPPO |
$599.75
|
| Rate for Payer: BCBS Trust/PPO |
$430.20
|
| Rate for Payer: BCN Commercial |
$430.20
|
| Rate for Payer: BCN Medicare Advantage |
$599.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.75
|
| Rate for Payer: Mclaren Medicaid |
$321.47
|
| Rate for Payer: Mclaren Medicare |
$599.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.74
|
| Rate for Payer: Meridian Medicaid |
$337.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.71
|
| Rate for Payer: Nomi Health Commercial |
$1,259.48
|
| Rate for Payer: PACE Medicare |
$569.76
|
| Rate for Payer: PACE SWMI |
$599.75
|
| Rate for Payer: PHP Medicare Advantage |
$599.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,885.01
|
| Rate for Payer: Priority Health Medicare |
$599.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,508.01
|
| Rate for Payer: Railroad Medicare Medicare |
$599.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.71
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.75
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$599.75
|
| Rate for Payer: UHCCP Medicaid |
$337.66
|
| Rate for Payer: VA VA |
$599.75
|
|
|
DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE
|
Facility
|
OP
|
$1,885.01
|
|
|
Service Code
|
CPT 11000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$1,885.01 |
| Rate for Payer: Aetna Medicare |
$623.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$749.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$749.69
|
| Rate for Payer: BCBS Complete |
$337.54
|
| Rate for Payer: BCBS MAPPO |
$599.75
|
| Rate for Payer: BCBS Trust/PPO |
$24.25
|
| Rate for Payer: BCN Commercial |
$24.25
|
| Rate for Payer: BCN Medicare Advantage |
$599.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.75
|
| Rate for Payer: Mclaren Medicaid |
$321.47
|
| Rate for Payer: Mclaren Medicare |
$599.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.74
|
| Rate for Payer: Meridian Medicaid |
$337.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.71
|
| Rate for Payer: Nomi Health Commercial |
$1,259.48
|
| Rate for Payer: PACE Medicare |
$569.76
|
| Rate for Payer: PACE SWMI |
$599.75
|
| Rate for Payer: PHP Medicare Advantage |
$599.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,885.01
|
| Rate for Payer: Priority Health Medicare |
$599.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,508.01
|
| Rate for Payer: Railroad Medicare Medicare |
$599.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.30
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.75
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$599.75
|
| Rate for Payer: UHCCP Medicaid |
$337.66
|
| Rate for Payer: VA VA |
$599.75
|
|
|
DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 11045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: BCBS Trust/PPO |
$84.12
|
| Rate for Payer: BCN Commercial |
$84.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.97
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,230.33
|
|
|
Service Code
|
CPT 11042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$63.86 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$184.43
|
| Rate for Payer: BCN Commercial |
$184.43
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.86
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$220.39
|
| Rate for Payer: VA VA |
$391.45
|
|
