|
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 |
$0.74 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.76
|
| Rate for Payer: BCBS Complete |
$0.77
|
| Rate for Payer: BCBS MAPPO |
$1.41
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| Rate for Payer: BCN Commercial |
$3.89
|
| Rate for Payer: BCN Medicare Advantage |
$1.41
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Advantage |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.41
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Mclaren Medicaid |
$0.74
|
| Rate for Payer: Mclaren Medicare |
$1.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.48
|
| Rate for Payer: Meridian Medicaid |
$1.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Nomi Health Commercial |
$4.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.16
|
| Rate for Payer: PACE Medicare |
$1.34
|
| Rate for Payer: PACE SWMI |
$1.41
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: PHP Medicare Advantage |
$1.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.84
|
| Rate for Payer: Priority Health Medicare |
$1.41
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: Priority Health Tiered Network |
$3.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.41
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Medicaid |
$0.74
|
| Rate for Payer: UHCCP Medicaid |
$0.74
|
| Rate for Payer: VA VA |
$1.41
|
|
|
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 Advantage |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| 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: Opus (Opus Packaging Group) HMA |
$2.16
|
| Rate for Payer: PHP Commercial |
$2.45
|
| 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 |
$0.74 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.76
|
| Rate for Payer: BCBS Complete |
$0.77
|
| Rate for Payer: BCBS MAPPO |
$1.41
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| Rate for Payer: BCN Commercial |
$3.89
|
| Rate for Payer: BCN Medicare Advantage |
$1.41
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Advantage |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.41
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Mclaren Medicaid |
$0.74
|
| Rate for Payer: Mclaren Medicare |
$1.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.48
|
| Rate for Payer: Meridian Medicaid |
$1.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Nomi Health Commercial |
$4.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.16
|
| Rate for Payer: PACE Medicare |
$1.34
|
| Rate for Payer: PACE SWMI |
$1.41
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: PHP Medicare Advantage |
$1.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.84
|
| Rate for Payer: Priority Health Medicare |
$1.41
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: Priority Health Tiered Network |
$3.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.41
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Medicaid |
$0.74
|
| Rate for Payer: UHCCP Medicaid |
$0.74
|
| Rate for Payer: VA VA |
$1.41
|
|
|
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 Advantage |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| 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: Opus (Opus Packaging Group) HMA |
$2.16
|
| Rate for Payer: PHP Commercial |
$2.45
|
| 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 |
$0.74 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.76
|
| Rate for Payer: BCBS Complete |
$0.77
|
| Rate for Payer: BCBS MAPPO |
$1.41
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| Rate for Payer: BCN Commercial |
$3.89
|
| Rate for Payer: BCN Medicare Advantage |
$1.41
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Advantage |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.41
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Mclaren Medicaid |
$0.74
|
| Rate for Payer: Mclaren Medicare |
$1.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.48
|
| Rate for Payer: Meridian Medicaid |
$1.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Nomi Health Commercial |
$4.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.16
|
| Rate for Payer: PACE Medicare |
$1.34
|
| Rate for Payer: PACE SWMI |
$1.41
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: PHP Medicare Advantage |
$1.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.84
|
| Rate for Payer: Priority Health Medicare |
$1.41
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: Priority Health Tiered Network |
$3.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.41
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Medicaid |
$0.74
|
| Rate for Payer: UHCCP Medicaid |
$0.74
|
| Rate for Payer: VA VA |
$1.41
|
|
|
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$4,245.61
|
|
|
Service Code
|
HCPCS J7511
|
| Hospital Charge Code |
24585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,674.73 |
| Max. Negotiated Rate |
$3,821.05 |
| Rate for Payer: Aetna Commercial |
$3,608.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,759.65
|
| Rate for Payer: Cash Price |
$3,396.49
|
| Rate for Payer: Cofinity Advantage |
$2,971.93
|
| Rate for Payer: Cofinity Commercial |
$3,651.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,396.49
|
| Rate for Payer: Healthscope Commercial |
$3,821.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,608.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,184.21
|
| Rate for Payer: PHP Commercial |
$3,608.77
|
| Rate for Payer: Priority Health SBD |
$2,674.73
|
|
|
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$4,245.61
|
|
|
Service Code
|
HCPCS J7511
|
| Hospital Charge Code |
24585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$535.09 |
| Max. Negotiated Rate |
$3,821.05 |
| Rate for Payer: Aetna Commercial |
$3,608.77
|
| Rate for Payer: Aetna Medicare |
$1,064.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,759.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,278.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,278.90
|
| Rate for Payer: BCBS Complete |
$561.90
|
| Rate for Payer: BCBS MAPPO |
$1,023.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,533.32
|
| Rate for Payer: BCN Commercial |
$2,533.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,023.12
|
| Rate for Payer: Cash Price |
$3,396.49
|
| Rate for Payer: Cash Price |
$3,396.49
|
| Rate for Payer: Cofinity Advantage |
$2,971.93
|
| Rate for Payer: Cofinity Commercial |
$3,651.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,396.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,023.12
|
| Rate for Payer: Healthscope Commercial |
$3,821.05
|
| Rate for Payer: Mclaren Medicaid |
$535.09
|
| Rate for Payer: Mclaren Medicare |
$1,023.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,074.28
|
| Rate for Payer: Meridian Medicaid |
$1,074.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,176.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,125.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,608.77
|
| Rate for Payer: Nomi Health Commercial |
$3,069.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,184.21
|
| Rate for Payer: PACE Medicare |
$971.96
|
| Rate for Payer: PACE SWMI |
$1,023.12
|
| Rate for Payer: PHP Commercial |
$3,608.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,023.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$535.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,151.97
|
| Rate for Payer: Priority Health Medicare |
$1,023.12
|
| Rate for Payer: Priority Health SBD |
$2,674.73
|
| Rate for Payer: Priority Health Tiered Network |
$2,521.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,023.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,666.09
|
| Rate for Payer: UHC Core |
$1,666.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,023.12
|
| Rate for Payer: UHC Exchange |
$1,666.09
|
| Rate for Payer: UHC Medicaid |
$535.09
|
| Rate for Payer: UHCCP Medicaid |
$535.09
|
| Rate for Payer: VA VA |
$1,023.12
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC
|
Facility
|
IP
|
$112,109.77
|
|
|
Service Code
|
MSDRG 268
|
| Min. Negotiated Rate |
$51,046.34 |
| Max. Negotiated Rate |
$112,109.77 |
| Rate for Payer: Aetna Medicare |
$55,882.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67,166.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67,166.24
|
| Rate for Payer: BCBS MAPPO |
$53,732.99
|
| Rate for Payer: BCBS Trust/PPO |
$107,517.63
|
| Rate for Payer: BCN Commercial |
$107,517.63
|
| Rate for Payer: BCN Medicare Advantage |
$53,732.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53,732.99
|
| Rate for Payer: Mclaren Medicare |
$53,732.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56,419.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61,792.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$59,106.29
|
| Rate for Payer: Nomi Health Commercial |
$88,724.91
|
| Rate for Payer: PACE Medicare |
$51,046.34
|
| Rate for Payer: PACE SWMI |
$53,732.99
|
| Rate for Payer: PHP Medicare Advantage |
$53,732.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$110,886.47
|
| Rate for Payer: Priority Health Medicare |
$53,732.99
|
| Rate for Payer: Priority Health Tiered Network |
$88,709.16
|
| Rate for Payer: Railroad Medicare Medicare |
$53,732.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112,109.77
|
| Rate for Payer: UHC Core |
$93,793.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$53,732.99
|
| Rate for Payer: UHC Exchange |
$76,599.17
|
| Rate for Payer: VA VA |
$53,732.99
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC
|
Facility
|
IP
|
$68,838.16
|
|
|
Service Code
|
MSDRG 269
|
| Min. Negotiated Rate |
$31,556.02 |
| Max. Negotiated Rate |
$68,838.16 |
| Rate for Payer: Aetna Medicare |
$34,545.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41,521.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41,521.07
|
| Rate for Payer: BCBS MAPPO |
$33,216.86
|
| Rate for Payer: BCBS Trust/PPO |
$67,447.81
|
| Rate for Payer: BCN Commercial |
$67,447.81
|
| Rate for Payer: BCN Medicare Advantage |
$33,216.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33,216.86
|
| Rate for Payer: Mclaren Medicare |
$33,216.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34,877.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38,199.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$36,538.55
|
| Rate for Payer: Nomi Health Commercial |
$54,479.28
|
| Rate for Payer: PACE Medicare |
$31,556.02
|
| Rate for Payer: PACE SWMI |
$33,216.86
|
| Rate for Payer: PHP Medicare Advantage |
$33,216.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$68,087.02
|
| Rate for Payer: Priority Health Medicare |
$33,216.86
|
| Rate for Payer: Priority Health Tiered Network |
$54,469.61
|
| Rate for Payer: Railroad Medicare Medicare |
$33,216.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68,838.16
|
| Rate for Payer: UHC Core |
$57,591.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33,216.86
|
| Rate for Payer: UHC Exchange |
$47,033.78
|
| Rate for Payer: VA VA |
$33,216.86
|
|
|
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 Advantage |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| 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: Opus (Opus Packaging Group) HMA |
$526.68
|
| Rate for Payer: PHP Commercial |
$596.90
|
| 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 |
$275.98 |
| 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 Advantage |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$561.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.68
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health SBD |
$442.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.46
|
| Rate for Payer: UHC Core |
$365.87
|
| Rate for Payer: UHC Exchange |
$275.98
|
|
|
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 Advantage |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| 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: Opus (Opus Packaging Group) HMA |
$526.68
|
| Rate for Payer: PHP Commercial |
$596.90
|
| 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 |
$275.98 |
| 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 Advantage |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$561.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.68
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health SBD |
$442.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.46
|
| Rate for Payer: UHC Core |
$365.87
|
| Rate for Payer: UHC Exchange |
$275.98
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$8,180.99
|
|
|
Service Code
|
APR-DRG 2332
|
| Min. Negotiated Rate |
$7,791.42 |
| Max. Negotiated Rate |
$8,180.99 |
| Rate for Payer: BCBS Complete |
$8,180.99
|
| Rate for Payer: Mclaren Medicaid |
$7,791.42
|
| Rate for Payer: Meridian Medicaid |
$8,180.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,791.42
|
| Rate for Payer: UHC Medicaid |
$7,791.42
|
| Rate for Payer: UHCCP Medicaid |
$7,791.42
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$20,315.46
|
|
|
Service Code
|
APR-DRG 2334
|
| Min. Negotiated Rate |
$19,348.06 |
| Max. Negotiated Rate |
$20,315.46 |
| Rate for Payer: BCBS Complete |
$20,315.46
|
| Rate for Payer: Mclaren Medicaid |
$19,348.06
|
| Rate for Payer: Meridian Medicaid |
$20,315.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,348.06
|
| Rate for Payer: UHC Medicaid |
$19,348.06
|
| Rate for Payer: UHCCP Medicaid |
$19,348.06
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$6,510.97
|
|
|
Service Code
|
APR-DRG 2331
|
| Min. Negotiated Rate |
$6,200.92 |
| Max. Negotiated Rate |
$6,510.97 |
| Rate for Payer: BCBS Complete |
$6,510.97
|
| Rate for Payer: Mclaren Medicaid |
$6,200.92
|
| Rate for Payer: Meridian Medicaid |
$6,510.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,200.92
|
| Rate for Payer: UHC Medicaid |
$6,200.92
|
| Rate for Payer: UHCCP Medicaid |
$6,200.92
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$12,597.69
|
|
|
Service Code
|
APR-DRG 2333
|
| Min. Negotiated Rate |
$11,997.80 |
| Max. Negotiated Rate |
$12,597.69 |
| Rate for Payer: BCBS Complete |
$12,597.69
|
| Rate for Payer: Mclaren Medicaid |
$11,997.80
|
| Rate for Payer: Meridian Medicaid |
$12,597.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,997.80
|
| Rate for Payer: UHC Medicaid |
$11,997.80
|
| Rate for Payer: UHCCP Medicaid |
$11,997.80
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$11,771.00
|
|
|
Service Code
|
APR-DRG 2343
|
| Min. Negotiated Rate |
$11,210.47 |
| Max. Negotiated Rate |
$11,771.00 |
| Rate for Payer: BCBS Complete |
$11,771.00
|
| Rate for Payer: Mclaren Medicaid |
$11,210.47
|
| Rate for Payer: Meridian Medicaid |
$11,771.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,210.47
|
| Rate for Payer: UHC Medicaid |
$11,210.47
|
| Rate for Payer: UHCCP Medicaid |
$11,210.47
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$16,124.64
|
|
|
Service Code
|
APR-DRG 2344
|
| Min. Negotiated Rate |
$15,356.80 |
| Max. Negotiated Rate |
$16,124.64 |
| Rate for Payer: BCBS Complete |
$16,124.64
|
| Rate for Payer: Mclaren Medicaid |
$15,356.80
|
| Rate for Payer: Meridian Medicaid |
$16,124.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,356.80
|
| Rate for Payer: UHC Medicaid |
$15,356.80
|
| Rate for Payer: UHCCP Medicaid |
$15,356.80
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$7,575.59
|
|
|
Service Code
|
APR-DRG 2342
|
| Min. Negotiated Rate |
$7,214.84 |
| Max. Negotiated Rate |
$7,575.59 |
| Rate for Payer: BCBS Complete |
$7,575.59
|
| Rate for Payer: Mclaren Medicaid |
$7,214.84
|
| Rate for Payer: Meridian Medicaid |
$7,575.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,214.84
|
| Rate for Payer: UHC Medicaid |
$7,214.84
|
| Rate for Payer: UHCCP Medicaid |
$7,214.84
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$6,209.41
|
|
|
Service Code
|
APR-DRG 2341
|
| Min. Negotiated Rate |
$5,913.73 |
| Max. Negotiated Rate |
$6,209.41 |
| Rate for Payer: BCBS Complete |
$6,209.41
|
| Rate for Payer: Mclaren Medicaid |
$5,913.73
|
| Rate for Payer: Meridian Medicaid |
$6,209.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,913.73
|
| Rate for Payer: UHC Medicaid |
$5,913.73
|
| Rate for Payer: UHCCP Medicaid |
$5,913.73
|
|
|
APPENDIX PROCEDURES WITH CC
|
Facility
|
IP
|
$26,926.22
|
|
|
Service Code
|
MSDRG 398
|
| Min. Negotiated Rate |
$11,662.64 |
| Max. Negotiated Rate |
$26,926.22 |
| Rate for Payer: Aetna Medicare |
$12,767.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,345.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,345.58
|
| Rate for Payer: BCBS MAPPO |
$12,276.46
|
| Rate for Payer: BCBS Trust/PPO |
$26,926.22
|
| Rate for Payer: BCN Commercial |
$26,926.22
|
| Rate for Payer: BCN Medicare Advantage |
$12,276.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,276.46
|
| Rate for Payer: Mclaren Medicare |
$12,276.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,890.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,117.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,504.11
|
| Rate for Payer: Nomi Health Commercial |
$19,525.44
|
| Rate for Payer: PACE Medicare |
$11,662.64
|
| Rate for Payer: PACE SWMI |
$12,276.46
|
| Rate for Payer: PHP Medicare Advantage |
$12,276.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,402.47
|
| Rate for Payer: Priority Health Medicare |
$12,276.46
|
| Rate for Payer: Priority Health Tiered Network |
$19,521.97
|
| Rate for Payer: Railroad Medicare Medicare |
$12,276.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,671.68
|
| Rate for Payer: UHC Core |
$20,640.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,276.46
|
| Rate for Payer: UHC Exchange |
$16,856.96
|
| Rate for Payer: VA VA |
$12,276.46
|
|
|
APPENDIX PROCEDURES WITH MCC
|
Facility
|
IP
|
$39,036.87
|
|
|
Service Code
|
MSDRG 397
|
| Min. Negotiated Rate |
$18,132.96 |
| Max. Negotiated Rate |
$39,036.87 |
| Rate for Payer: Aetna Medicare |
$19,850.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,859.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,859.16
|
| Rate for Payer: BCBS MAPPO |
$19,087.33
|
| Rate for Payer: BCBS Trust/PPO |
$30,772.16
|
| Rate for Payer: BCN Commercial |
$30,772.16
|
| Rate for Payer: BCN Medicare Advantage |
$19,087.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,087.33
|
| Rate for Payer: Mclaren Medicare |
$19,087.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,041.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,950.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,996.06
|
| Rate for Payer: Nomi Health Commercial |
$30,894.21
|
| Rate for Payer: PACE Medicare |
$18,132.96
|
| Rate for Payer: PACE SWMI |
$19,087.33
|
| Rate for Payer: PHP Medicare Advantage |
$19,087.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38,610.91
|
| Rate for Payer: Priority Health Medicare |
$19,087.33
|
| Rate for Payer: Priority Health Tiered Network |
$30,888.73
|
| Rate for Payer: Railroad Medicare Medicare |
$19,087.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39,036.87
|
| Rate for Payer: UHC Core |
$32,659.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,087.33
|
| Rate for Payer: UHC Exchange |
$26,672.00
|
| Rate for Payer: VA VA |
$19,087.33
|
|
|
APPENDIX PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$22,661.28
|
|
|
Service Code
|
MSDRG 399
|
| Min. Negotiated Rate |
$8,954.23 |
| Max. Negotiated Rate |
$22,661.28 |
| Rate for Payer: Aetna Medicare |
$9,802.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,781.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,781.88
|
| Rate for Payer: BCBS MAPPO |
$9,425.50
|
| Rate for Payer: BCBS Trust/PPO |
$22,661.28
|
| Rate for Payer: BCN Commercial |
$22,661.28
|
| Rate for Payer: BCN Medicare Advantage |
$9,425.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,425.50
|
| Rate for Payer: Mclaren Medicare |
$9,425.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,896.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,839.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,368.05
|
| Rate for Payer: Nomi Health Commercial |
$14,766.63
|
| Rate for Payer: PACE Medicare |
$8,954.23
|
| Rate for Payer: PACE SWMI |
$9,425.50
|
| Rate for Payer: PHP Medicare Advantage |
$9,425.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,455.01
|
| Rate for Payer: Priority Health Medicare |
$9,425.50
|
| Rate for Payer: Priority Health Tiered Network |
$14,764.01
|
| Rate for Payer: Railroad Medicare Medicare |
$9,425.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,658.61
|
| Rate for Payer: UHC Core |
$15,610.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,425.50
|
| Rate for Payer: UHC Exchange |
$12,748.52
|
| Rate for Payer: VA VA |
$9,425.50
|
|
|
APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT)
|
Facility
|
OP
|
$523.62
|
|
|
Service Code
|
CPT 29515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$523.62 |
| Rate for Payer: Aetna Medicare |
$168.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.40
|
| Rate for Payer: BCBS Complete |
$88.93
|
| Rate for Payer: BCBS MAPPO |
$161.92
|
| Rate for Payer: BCBS Trust/PPO |
$81.15
|
| Rate for Payer: BCN Commercial |
$81.15
|
| Rate for Payer: BCN Medicare Advantage |
$161.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.92
|
| Rate for Payer: Mclaren Medicaid |
$84.68
|
| Rate for Payer: Mclaren Medicare |
$161.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.02
|
| Rate for Payer: Meridian Medicaid |
$170.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$178.11
|
| Rate for Payer: Nomi Health Commercial |
$485.76
|
| Rate for Payer: PACE Medicare |
$153.82
|
| Rate for Payer: PACE SWMI |
$161.92
|
| Rate for Payer: PHP Medicare Advantage |
$161.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$523.62
|
| Rate for Payer: Priority Health Medicare |
$161.92
|
| Rate for Payer: Priority Health Tiered Network |
$418.90
|
| Rate for Payer: Railroad Medicare Medicare |
$161.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.92
|
| Rate for Payer: UHC Medicaid |
$84.68
|
| Rate for Payer: UHCCP Medicaid |
$84.68
|
| Rate for Payer: VA VA |
$161.92
|
|
