|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 2,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.93
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.54
|
| Rate for Payer: BCN Medicare Advantage |
$1.54
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Mclaren Medicaid |
$0.83
|
| Rate for Payer: Mclaren Medicare |
$1.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.62
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: PACE Medicare |
$1.46
|
| Rate for Payer: PACE SWMI |
$1.54
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: PHP Medicare Advantage |
$1.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health Medicare |
$1.54
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: Railroad Medicare Medicare |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.54
|
| Rate for Payer: UHC Medicare Advantage |
$1.54
|
| Rate for Payer: UHCCP Medicaid |
$0.87
|
| Rate for Payer: VA VA |
$1.54
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 2,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.81
|
|
|
ANTIHEMOPHILIC FVIII, B-DOM TRUNCATED 250 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.93
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.54
|
| Rate for Payer: BCN Medicare Advantage |
$1.54
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Mclaren Medicaid |
$0.83
|
| Rate for Payer: Mclaren Medicare |
$1.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.62
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: PACE Medicare |
$1.46
|
| Rate for Payer: PACE SWMI |
$1.54
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: PHP Medicare Advantage |
$1.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health Medicare |
$1.54
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: Railroad Medicare Medicare |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.54
|
| Rate for Payer: UHC Medicare Advantage |
$1.54
|
| Rate for Payer: UHCCP Medicaid |
$0.87
|
| Rate for Payer: VA VA |
$1.54
|
|
|
ANTIHEMOPHILIC FVIII, B-DOM TRUNCATED 250 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.81
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 3,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174375
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.81
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 3,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174375
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.93
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.54
|
| Rate for Payer: BCN Medicare Advantage |
$1.54
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Mclaren Medicaid |
$0.83
|
| Rate for Payer: Mclaren Medicare |
$1.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.62
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: PACE Medicare |
$1.46
|
| Rate for Payer: PACE SWMI |
$1.54
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: PHP Medicare Advantage |
$1.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health Medicare |
$1.54
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: Railroad Medicare Medicare |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.54
|
| Rate for Payer: UHC Medicare Advantage |
$1.54
|
| Rate for Payer: UHCCP Medicaid |
$0.87
|
| Rate for Payer: VA VA |
$1.54
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 500 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.81
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 500 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.93
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.54
|
| Rate for Payer: BCN Medicare Advantage |
$1.54
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Mclaren Medicaid |
$0.83
|
| Rate for Payer: Mclaren Medicare |
$1.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.62
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: PACE Medicare |
$1.46
|
| Rate for Payer: PACE SWMI |
$1.54
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: PHP Medicare Advantage |
$1.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health Medicare |
$1.54
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: Railroad Medicare Medicare |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.54
|
| Rate for Payer: UHC Medicare Advantage |
$1.54
|
| Rate for Payer: UHCCP Medicaid |
$0.87
|
| Rate for Payer: VA VA |
$1.54
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
|
IP
|
$702.24
|
|
|
Service Code
|
NDC 00003089331
|
| Hospital Charge Code |
163984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$442.41 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$491.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.46
|
| Rate for Payer: Priority Health SBD |
$442.41
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
|
OP
|
$702.24
|
|
|
Service Code
|
NDC 00003089331
|
| Hospital Charge Code |
163984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.90 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna Medicare |
$351.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: BCBS Complete |
$280.90
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$491.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.46
|
| Rate for Payer: Priority Health SBD |
$442.41
|
|
|
APIXABAN 5 MG TABLET
|
Facility
|
OP
|
$702.24
|
|
|
Service Code
|
NDC 00003089431
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.90 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna Medicare |
$351.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: BCBS Complete |
$280.90
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$491.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.46
|
| Rate for Payer: Priority Health SBD |
$442.41
|
|
|
APIXABAN 5 MG TABLET
|
Facility
|
IP
|
$702.24
|
|
|
Service Code
|
NDC 00003089431
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$442.41 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$491.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.46
|
| Rate for Payer: Priority Health SBD |
$442.41
|
|
|
APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND)
|
Facility
|
OP
|
$433.18
|
|
|
Service Code
|
CPT 29105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$433.18 |
| Rate for Payer: Aetna Medicare |
$160.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$86.64
|
| Rate for Payer: VA VA |
$153.89
|
|
|
APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR TOES)
|
Facility
|
OP
|
$433.18
|
|
|
Service Code
|
CPT 29505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$433.18 |
| Rate for Payer: Aetna Medicare |
$160.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$86.64
|
| Rate for Payer: VA VA |
$153.89
|
|
|
APPLICATION OF LOW COST SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; FIRST 25 SQ CM OR LESS WOUND SURFACE AREA
|
Facility
|
OP
|
$1,680.50
|
|
|
Service Code
|
CPT C5271
|
|
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
|
|
|
APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC
|
Facility
|
OP
|
$353.86
|
|
|
Service Code
|
CPT 29125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$70.77
|
| Rate for Payer: VA VA |
$125.71
|
|
|
APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT)
|
Facility
|
OP
|
$433.18
|
|
|
Service Code
|
CPT 29515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$433.18 |
| Rate for Payer: Aetna Medicare |
$160.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$86.64
|
| Rate for Payer: VA VA |
$153.89
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; FIRST 25 SQ CM OR LESS WOUND SURFACE AREA
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 15275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$1,004.40
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; FIRST 25 SQ CM OR LESS WOUND SURFACE AREA
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 15271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$1,004.40
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
APR-DRG 42.00: ABDOMINAL PAIN
|
Facility
|
IP
|
$5,086.01
|
|
|
Service Code
|
APR-DRG 2513
|
| Min. Negotiated Rate |
$4,843.82 |
| Max. Negotiated Rate |
$5,086.01 |
| Rate for Payer: BCBS Complete |
$5,086.01
|
| Rate for Payer: Mclaren Medicaid |
$4,843.82
|
| Rate for Payer: Meridian Medicaid |
$5,086.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,843.82
|
| Rate for Payer: UHCCP Medicaid |
$5,086.01
|
|
|
APR-DRG 42.00: ABDOMINAL PAIN
|
Facility
|
IP
|
$3,895.67
|
|
|
Service Code
|
APR-DRG 2512
|
| Min. Negotiated Rate |
$3,710.16 |
| Max. Negotiated Rate |
$3,895.67 |
| Rate for Payer: BCBS Complete |
$3,895.67
|
| Rate for Payer: Mclaren Medicaid |
$3,710.16
|
| Rate for Payer: Meridian Medicaid |
$3,895.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,710.16
|
| Rate for Payer: UHCCP Medicaid |
$3,895.67
|
|
|
APR-DRG 42.00: ABDOMINAL PAIN
|
Facility
|
IP
|
$3,084.07
|
|
|
Service Code
|
APR-DRG 2511
|
| Min. Negotiated Rate |
$2,937.21 |
| Max. Negotiated Rate |
$3,084.07 |
| Rate for Payer: BCBS Complete |
$3,084.07
|
| Rate for Payer: Mclaren Medicaid |
$2,937.21
|
| Rate for Payer: Meridian Medicaid |
$3,084.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,937.21
|
| Rate for Payer: UHCCP Medicaid |
$3,084.07
|
|
|
APR-DRG 42.00: ABDOMINAL PAIN
|
Facility
|
IP
|
$8,007.76
|
|
|
Service Code
|
APR-DRG 2514
|
| Min. Negotiated Rate |
$7,626.44 |
| Max. Negotiated Rate |
$8,007.76 |
| Rate for Payer: BCBS Complete |
$8,007.76
|
| Rate for Payer: Mclaren Medicaid |
$7,626.44
|
| Rate for Payer: Meridian Medicaid |
$8,007.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,626.44
|
| Rate for Payer: UHCCP Medicaid |
$8,007.76
|
|
|
APR-DRG 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$3,084.07
|
|
|
Service Code
|
APR-DRG 5431
|
| Min. Negotiated Rate |
$2,937.21 |
| Max. Negotiated Rate |
$3,084.07 |
| Rate for Payer: BCBS Complete |
$3,084.07
|
| Rate for Payer: Mclaren Medicaid |
$2,937.21
|
| Rate for Payer: Meridian Medicaid |
$3,084.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,937.21
|
| Rate for Payer: UHCCP Medicaid |
$3,084.07
|
|
|
APR-DRG 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$12,228.07
|
|
|
Service Code
|
APR-DRG 5434
|
| Min. Negotiated Rate |
$11,645.78 |
| Max. Negotiated Rate |
$12,228.07 |
| Rate for Payer: BCBS Complete |
$12,228.07
|
| Rate for Payer: Mclaren Medicaid |
$11,645.78
|
| Rate for Payer: Meridian Medicaid |
$12,228.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,645.78
|
| Rate for Payer: UHCCP Medicaid |
$12,228.07
|
|
