|
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC
|
Facility
IP
|
$13,155.64
|
|
|
Service Code
|
MS-DRG 554
|
| Min. Negotiated Rate |
$6,090.61 |
| Max. Negotiated Rate |
$13,155.64 |
| Rate for Payer: Aetna Medicare |
$6,667.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,013.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,013.96
|
| Rate for Payer: BCBS MAPPO |
$6,411.17
|
| Rate for Payer: BCBS Trust/PPO |
$13,155.64
|
| Rate for Payer: BCN Medicare Advantage |
$6,411.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,411.17
|
| Rate for Payer: Mclaren Medicare |
$6,411.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,731.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,372.85
|
| Rate for Payer: PACE Medicare |
$6,090.61
|
| Rate for Payer: PACE SWMI |
$6,411.17
|
| Rate for Payer: PHP Medicare Advantage |
$6,411.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,792.76
|
| Rate for Payer: Priority Health Medicare |
$6,411.17
|
| Rate for Payer: Priority Health Narrow Network |
$9,434.21
|
| Rate for Payer: Railroad Medicare Medicare |
$6,411.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,535.74
|
| Rate for Payer: UHC Core |
$7,692.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,411.17
|
| Rate for Payer: UHC Exchange |
$8,238.55
|
| Rate for Payer: UHC Medicare Advantage |
$6,603.51
|
| Rate for Payer: VA VA |
$6,411.17
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION
|
Facility
OP
|
$263.53
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
35839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$237.18 |
| Rate for Payer: Aetna Commercial |
$224.00
|
| Rate for Payer: Aetna Medicare |
$2.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.45
|
| Rate for Payer: BCBS Complete |
$1.13
|
| Rate for Payer: BCBS MAPPO |
$1.96
|
| Rate for Payer: BCBS Trust/PPO |
$5.78
|
| Rate for Payer: BCN Medicare Advantage |
$1.96
|
| Rate for Payer: Cash Price |
$210.82
|
| Rate for Payer: Cash Price |
$210.82
|
| Rate for Payer: Cofinity Commercial |
$184.47
|
| Rate for Payer: Cofinity Commercial |
$226.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.96
|
| Rate for Payer: Healthscope Commercial |
$237.18
|
| Rate for Payer: Mclaren Medicaid |
$1.07
|
| Rate for Payer: Mclaren Medicare |
$1.96
|
| Rate for Payer: Meridian Medicaid |
$1.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.00
|
| Rate for Payer: PACE Medicare |
$1.86
|
| Rate for Payer: PACE SWMI |
$1.96
|
| Rate for Payer: PHP Commercial |
$224.00
|
| Rate for Payer: PHP Medicare Advantage |
$1.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.47
|
| Rate for Payer: Priority Health Medicare |
$1.96
|
| Rate for Payer: Priority Health SBD |
$166.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.96
|
| Rate for Payer: UHC Medicare Advantage |
$2.02
|
| Rate for Payer: VA VA |
$1.96
|
|
|
BORTEZOMIB 3.5 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
IP
|
$6,907.69
|
|
|
Service Code
|
HCPCS J9048
|
| Hospital Charge Code |
185652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,351.84 |
| Max. Negotiated Rate |
$6,216.92 |
| Rate for Payer: Aetna Commercial |
$5,871.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,490.00
|
| Rate for Payer: Cash Price |
$5,526.15
|
| Rate for Payer: Cofinity Commercial |
$4,835.38
|
| Rate for Payer: Cofinity Commercial |
$5,940.61
|
| Rate for Payer: Healthscope Commercial |
$6,216.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,871.54
|
| Rate for Payer: PHP Commercial |
$5,871.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,835.38
|
| Rate for Payer: Priority Health SBD |
$4,351.84
|
|
|
BORTEZOMIB 3.5 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
OP
|
$6,907.69
|
|
|
Service Code
|
HCPCS J9048
|
| Hospital Charge Code |
185652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$6,216.92 |
| Rate for Payer: Aetna Commercial |
$5,871.54
|
| Rate for Payer: Aetna Medicare |
$50.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,490.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.68
|
| Rate for Payer: BCBS Complete |
$27.89
|
| Rate for Payer: BCBS MAPPO |
$48.55
|
| Rate for Payer: BCBS Trust/PPO |
$7.90
|
| Rate for Payer: BCN Medicare Advantage |
$48.55
|
| Rate for Payer: Cash Price |
$5,526.15
|
| Rate for Payer: Cash Price |
$5,526.15
|
| Rate for Payer: Cofinity Commercial |
$4,835.38
|
| Rate for Payer: Cofinity Commercial |
$5,940.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.55
|
| Rate for Payer: Healthscope Commercial |
$6,216.92
|
| Rate for Payer: Mclaren Medicaid |
$26.56
|
| Rate for Payer: Mclaren Medicare |
$48.55
|
| Rate for Payer: Meridian Medicaid |
$27.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,871.54
|
| Rate for Payer: PACE Medicare |
$46.12
|
| Rate for Payer: PACE SWMI |
$48.55
|
| Rate for Payer: PHP Commercial |
$5,871.54
|
| Rate for Payer: PHP Medicare Advantage |
$48.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,835.38
|
| Rate for Payer: Priority Health Medicare |
$48.55
|
| Rate for Payer: Priority Health SBD |
$4,351.84
|
| Rate for Payer: Railroad Medicare Medicare |
$48.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.55
|
| Rate for Payer: UHC Medicare Advantage |
$50.00
|
| Rate for Payer: VA VA |
$48.55
|
|
|
BORTEZOMIB 3.5 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
OP
|
$263.53
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
185652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$237.18 |
| Rate for Payer: Aetna Commercial |
$224.00
|
| Rate for Payer: Aetna Medicare |
$2.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.45
|
| Rate for Payer: BCBS Complete |
$1.13
|
| Rate for Payer: BCBS MAPPO |
$1.96
|
| Rate for Payer: BCBS Trust/PPO |
$5.78
|
| Rate for Payer: BCN Medicare Advantage |
$1.96
|
| Rate for Payer: Cash Price |
$210.82
|
| Rate for Payer: Cash Price |
$210.82
|
| Rate for Payer: Cofinity Commercial |
$226.64
|
| Rate for Payer: Cofinity Commercial |
$184.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.96
|
| Rate for Payer: Healthscope Commercial |
$237.18
|
| Rate for Payer: Mclaren Medicaid |
$1.07
|
| Rate for Payer: Mclaren Medicare |
$1.96
|
| Rate for Payer: Meridian Medicaid |
$1.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.00
|
| Rate for Payer: PACE Medicare |
$1.86
|
| Rate for Payer: PACE SWMI |
$1.96
|
| Rate for Payer: PHP Commercial |
$224.00
|
| Rate for Payer: PHP Medicare Advantage |
$1.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.47
|
| Rate for Payer: Priority Health Medicare |
$1.96
|
| Rate for Payer: Priority Health SBD |
$166.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.96
|
| Rate for Payer: UHC Medicare Advantage |
$2.02
|
| Rate for Payer: VA VA |
$1.96
|
|
|
BORTEZOMIB 3.5 MG SUBCUTANEOUS INJECTION
|
Facility
OP
|
$263.53
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
151057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$237.18 |
| Rate for Payer: Aetna Commercial |
$224.00
|
| Rate for Payer: Aetna Medicare |
$2.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.45
|
| Rate for Payer: BCBS Complete |
$1.13
|
| Rate for Payer: BCBS MAPPO |
$1.96
|
| Rate for Payer: BCBS Trust/PPO |
$5.78
|
| Rate for Payer: BCN Medicare Advantage |
$1.96
|
| Rate for Payer: Cash Price |
$210.82
|
| Rate for Payer: Cash Price |
$210.82
|
| Rate for Payer: Cofinity Commercial |
$226.64
|
| Rate for Payer: Cofinity Commercial |
$184.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.96
|
| Rate for Payer: Healthscope Commercial |
$237.18
|
| Rate for Payer: Mclaren Medicaid |
$1.07
|
| Rate for Payer: Mclaren Medicare |
$1.96
|
| Rate for Payer: Meridian Medicaid |
$1.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.00
|
| Rate for Payer: PACE Medicare |
$1.86
|
| Rate for Payer: PACE SWMI |
$1.96
|
| Rate for Payer: PHP Commercial |
$224.00
|
| Rate for Payer: PHP Medicare Advantage |
$1.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.47
|
| Rate for Payer: Priority Health Medicare |
$1.96
|
| Rate for Payer: Priority Health SBD |
$166.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.96
|
| Rate for Payer: UHC Medicare Advantage |
$2.02
|
| Rate for Payer: VA VA |
$1.96
|
|
|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC
|
Facility
IP
|
$56,118.42
|
|
|
Service Code
|
MS-DRG 584
|
| Min. Negotiated Rate |
$13,868.26 |
| Max. Negotiated Rate |
$56,118.42 |
| Rate for Payer: Aetna Medicare |
$15,182.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,247.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,247.71
|
| Rate for Payer: BCBS MAPPO |
$14,598.17
|
| Rate for Payer: BCBS Trust/PPO |
$56,118.42
|
| Rate for Payer: BCN Medicare Advantage |
$14,598.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,598.17
|
| Rate for Payer: Mclaren Medicare |
$14,598.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,328.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,787.90
|
| Rate for Payer: PACE Medicare |
$13,868.26
|
| Rate for Payer: PACE SWMI |
$14,598.17
|
| Rate for Payer: PHP Medicare Advantage |
$14,598.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,105.75
|
| Rate for Payer: Priority Health Medicare |
$14,598.17
|
| Rate for Payer: Priority Health Narrow Network |
$22,484.60
|
| Rate for Payer: Railroad Medicare Medicare |
$14,598.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,876.48
|
| Rate for Payer: UHC Core |
$18,332.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,598.17
|
| Rate for Payer: UHC Exchange |
$19,634.97
|
| Rate for Payer: UHC Medicare Advantage |
$15,036.12
|
| Rate for Payer: VA VA |
$14,598.17
|
|
|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$48,964.18
|
|
|
Service Code
|
MS-DRG 585
|
| Min. Negotiated Rate |
$11,989.51 |
| Max. Negotiated Rate |
$48,964.18 |
| Rate for Payer: Aetna Medicare |
$13,125.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,775.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,775.68
|
| Rate for Payer: BCBS MAPPO |
$12,620.54
|
| Rate for Payer: BCBS Trust/PPO |
$48,964.18
|
| Rate for Payer: BCN Medicare Advantage |
$12,620.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,620.54
|
| Rate for Payer: Mclaren Medicare |
$12,620.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,251.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,513.62
|
| Rate for Payer: PACE Medicare |
$11,989.51
|
| Rate for Payer: PACE SWMI |
$12,620.54
|
| Rate for Payer: PHP Medicare Advantage |
$12,620.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,165.27
|
| Rate for Payer: Priority Health Medicare |
$12,620.54
|
| Rate for Payer: Priority Health Narrow Network |
$19,332.22
|
| Rate for Payer: Railroad Medicare Medicare |
$12,620.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,687.74
|
| Rate for Payer: UHC Core |
$15,762.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,620.54
|
| Rate for Payer: UHC Exchange |
$16,882.10
|
| Rate for Payer: UHC Medicare Advantage |
$12,999.16
|
| Rate for Payer: VA VA |
$12,620.54
|
|
|
BREAST REDUCTION
|
Facility
OP
|
$17,231.52
|
|
|
Service Code
|
CPT 19318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,074.99 |
| Max. Negotiated Rate |
$17,231.52 |
| Rate for Payer: Aetna Medicare |
$6,034.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,253.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,253.02
|
| Rate for Payer: BCBS Complete |
$3,332.91
|
| Rate for Payer: BCBS MAPPO |
$5,802.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,799.38
|
| Rate for Payer: BCN Medicare Advantage |
$5,802.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,802.42
|
| Rate for Payer: Mclaren Medicaid |
$3,173.92
|
| Rate for Payer: Mclaren Medicare |
$5,802.42
|
| Rate for Payer: Meridian Medicaid |
$3,332.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,092.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,672.78
|
| Rate for Payer: PACE Medicare |
$5,512.30
|
| Rate for Payer: PACE SWMI |
$5,802.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,802.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,173.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,231.52
|
| Rate for Payer: Priority Health Medicare |
$5,802.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,785.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,802.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,182.49
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,802.42
|
| Rate for Payer: UHC Exchange |
$1,074.99
|
| Rate for Payer: UHC Medicare Advantage |
$5,976.49
|
| Rate for Payer: VA VA |
$5,802.42
|
|
|
BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$50,745.98
|
|
|
Service Code
|
HCPCS J9042
|
| Hospital Charge Code |
153416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31,969.97 |
| Max. Negotiated Rate |
$45,671.38 |
| Rate for Payer: Aetna Commercial |
$43,134.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,984.89
|
| Rate for Payer: Cash Price |
$40,596.78
|
| Rate for Payer: Cofinity Commercial |
$35,522.19
|
| Rate for Payer: Cofinity Commercial |
$43,641.54
|
| Rate for Payer: Healthscope Commercial |
$45,671.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43,134.08
|
| Rate for Payer: PHP Commercial |
$43,134.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35,522.19
|
| Rate for Payer: Priority Health SBD |
$31,969.97
|
|
|
BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION
|
Facility
OP
|
$50,745.98
|
|
|
Service Code
|
HCPCS J9042
|
| Hospital Charge Code |
153416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.15 |
| Max. Negotiated Rate |
$45,671.38 |
| Rate for Payer: Aetna Commercial |
$43,134.08
|
| Rate for Payer: Aetna Medicare |
$239.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,984.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$288.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$288.27
|
| Rate for Payer: BCBS Complete |
$132.46
|
| Rate for Payer: BCBS MAPPO |
$230.61
|
| Rate for Payer: BCBS Trust/PPO |
$682.72
|
| Rate for Payer: BCN Medicare Advantage |
$230.61
|
| Rate for Payer: Cash Price |
$40,596.78
|
| Rate for Payer: Cash Price |
$40,596.78
|
| Rate for Payer: Cofinity Commercial |
$35,522.19
|
| Rate for Payer: Cofinity Commercial |
$43,641.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.61
|
| Rate for Payer: Healthscope Commercial |
$45,671.38
|
| Rate for Payer: Mclaren Medicaid |
$126.15
|
| Rate for Payer: Mclaren Medicare |
$230.61
|
| Rate for Payer: Meridian Medicaid |
$132.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$242.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$265.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43,134.08
|
| Rate for Payer: PACE Medicare |
$219.08
|
| Rate for Payer: PACE SWMI |
$230.61
|
| Rate for Payer: PHP Commercial |
$43,134.08
|
| Rate for Payer: PHP Medicare Advantage |
$230.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35,522.19
|
| Rate for Payer: Priority Health Medicare |
$230.61
|
| Rate for Payer: Priority Health SBD |
$31,969.97
|
| Rate for Payer: Railroad Medicare Medicare |
$230.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.61
|
| Rate for Payer: UHC Medicare Advantage |
$237.53
|
| Rate for Payer: VA VA |
$230.61
|
|
|
BREXPIPRAZOLE 3 MG TABLET
|
Facility
IP
|
$4,882.89
|
|
|
Service Code
|
NDC 59148-039-13
|
| Hospital Charge Code |
174668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$4,394.60 |
| Rate for Payer: Aetna Commercial |
$4,150.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,173.88
|
| Rate for Payer: Cash Price |
$3,906.31
|
| Rate for Payer: Cofinity Commercial |
$3,418.02
|
| Rate for Payer: Cofinity Commercial |
$4,199.29
|
| Rate for Payer: Healthscope Commercial |
$4,394.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,150.46
|
| Rate for Payer: PHP Commercial |
$4,150.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,418.02
|
| Rate for Payer: Priority Health SBD |
$3,076.22
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
IP
|
$674.73
|
|
|
Service Code
|
NDC 0023-9177-05
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$425.08 |
| Max. Negotiated Rate |
$607.26 |
| Rate for Payer: Aetna Commercial |
$573.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.57
|
| Rate for Payer: Cash Price |
$539.78
|
| Rate for Payer: Cofinity Commercial |
$472.31
|
| Rate for Payer: Cofinity Commercial |
$580.27
|
| Rate for Payer: Healthscope Commercial |
$607.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.52
|
| Rate for Payer: PHP Commercial |
$573.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.31
|
| Rate for Payer: Priority Health SBD |
$425.08
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
IP
|
$408.87
|
|
|
Service Code
|
NDC 82182-773-05
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.59 |
| Max. Negotiated Rate |
$367.98 |
| Rate for Payer: Aetna Commercial |
$347.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.77
|
| Rate for Payer: Cash Price |
$327.10
|
| Rate for Payer: Cofinity Commercial |
$286.21
|
| Rate for Payer: Cofinity Commercial |
$351.63
|
| Rate for Payer: Healthscope Commercial |
$367.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$347.54
|
| Rate for Payer: PHP Commercial |
$347.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.21
|
| Rate for Payer: Priority Health SBD |
$257.59
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
IP
|
$499.17
|
|
|
Service Code
|
NDC 61314-144-05
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.48 |
| Max. Negotiated Rate |
$449.25 |
| Rate for Payer: Aetna Commercial |
$424.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.46
|
| Rate for Payer: Cash Price |
$399.34
|
| Rate for Payer: Cofinity Commercial |
$349.42
|
| Rate for Payer: Cofinity Commercial |
$429.29
|
| Rate for Payer: Healthscope Commercial |
$449.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$424.29
|
| Rate for Payer: PHP Commercial |
$424.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.42
|
| Rate for Payer: Priority Health SBD |
$314.48
|
|
|
BRIVARACETAM 10 MG/ML ORAL SOLUTION
|
Facility
IP
|
$4,945.05
|
|
|
Service Code
|
NDC 50474-870-15
|
| Hospital Charge Code |
178914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,115.38 |
| Max. Negotiated Rate |
$4,450.54 |
| Rate for Payer: Aetna Commercial |
$4,203.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,214.28
|
| Rate for Payer: Cash Price |
$3,956.04
|
| Rate for Payer: Cofinity Commercial |
$4,252.74
|
| Rate for Payer: Cofinity Commercial |
$3,461.54
|
| Rate for Payer: Healthscope Commercial |
$4,450.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,203.29
|
| Rate for Payer: PHP Commercial |
$4,203.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,461.54
|
| Rate for Payer: Priority Health SBD |
$3,115.38
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
IP
|
$198.44
|
|
|
Service Code
|
NDC 0574-0106-03
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.02 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Aetna Commercial |
$168.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.99
|
| Rate for Payer: Cash Price |
$158.75
|
| Rate for Payer: Cofinity Commercial |
$138.91
|
| Rate for Payer: Cofinity Commercial |
$170.66
|
| Rate for Payer: Healthscope Commercial |
$178.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.67
|
| Rate for Payer: PHP Commercial |
$168.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.91
|
| Rate for Payer: Priority Health SBD |
$125.02
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
IP
|
$636.48
|
|
|
Service Code
|
NDC 60687-286-21
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$400.98 |
| Max. Negotiated Rate |
$572.83 |
| Rate for Payer: Aetna Commercial |
$541.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.71
|
| Rate for Payer: Cash Price |
$509.18
|
| Rate for Payer: Cofinity Commercial |
$445.54
|
| Rate for Payer: Cofinity Commercial |
$547.37
|
| Rate for Payer: Healthscope Commercial |
$572.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$541.01
|
| Rate for Payer: PHP Commercial |
$541.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.54
|
| Rate for Payer: Priority Health SBD |
$400.98
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
IP
|
$21.22
|
|
|
Service Code
|
NDC 60687-286-11
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.04
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.85
|
| Rate for Payer: Priority Health SBD |
$13.37
|
|
|
BROMPHENIRAMINE-PSEUDOEPHEDRINE 1 MG-15 MG/5 ML ORAL LIQUID
|
Facility
IP
|
$644.70
|
|
|
Service Code
|
NDC 0485-0206-16
|
| Hospital Charge Code |
29801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$406.16 |
| Max. Negotiated Rate |
$580.23 |
| Rate for Payer: Aetna Commercial |
$548.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.06
|
| Rate for Payer: Cash Price |
$515.76
|
| Rate for Payer: Cofinity Commercial |
$451.29
|
| Rate for Payer: Cofinity Commercial |
$554.44
|
| Rate for Payer: Healthscope Commercial |
$580.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$548.00
|
| Rate for Payer: PHP Commercial |
$548.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$451.29
|
| Rate for Payer: Priority Health SBD |
$406.16
|
|
|
BRONCHITIS AND ASTHMA WITH CC/MCC
|
Facility
IP
|
$14,605.71
|
|
|
Service Code
|
MS-DRG 202
|
| Min. Negotiated Rate |
$7,019.02 |
| Max. Negotiated Rate |
$14,605.71 |
| Rate for Payer: Aetna Medicare |
$7,683.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,235.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,235.55
|
| Rate for Payer: BCBS MAPPO |
$7,388.44
|
| Rate for Payer: BCBS Trust/PPO |
$10,889.47
|
| Rate for Payer: BCN Medicare Advantage |
$7,388.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,388.44
|
| Rate for Payer: Mclaren Medicare |
$7,388.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,757.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,496.71
|
| Rate for Payer: PACE Medicare |
$7,019.02
|
| Rate for Payer: PACE SWMI |
$7,388.44
|
| Rate for Payer: PHP Medicare Advantage |
$7,388.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,740.05
|
| Rate for Payer: Priority Health Medicare |
$7,388.44
|
| Rate for Payer: Priority Health Narrow Network |
$10,992.04
|
| Rate for Payer: Railroad Medicare Medicare |
$7,388.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,605.71
|
| Rate for Payer: UHC Core |
$8,962.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,388.44
|
| Rate for Payer: UHC Exchange |
$9,598.94
|
| Rate for Payer: UHC Medicare Advantage |
$7,610.09
|
| Rate for Payer: VA VA |
$7,388.44
|
|
|
BRONCHITIS AND ASTHMA WITHOUT CC/MCC
|
Facility
IP
|
$10,600.00
|
|
|
Service Code
|
MS-DRG 203
|
| Min. Negotiated Rate |
$5,222.39 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: Aetna Medicare |
$5,717.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,871.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,871.56
|
| Rate for Payer: BCBS MAPPO |
$5,497.25
|
| Rate for Payer: BCBS Trust/PPO |
$5,972.85
|
| Rate for Payer: BCN Medicare Advantage |
$5,497.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,497.25
|
| Rate for Payer: Mclaren Medicare |
$5,497.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,772.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,321.84
|
| Rate for Payer: PACE Medicare |
$5,222.39
|
| Rate for Payer: PACE SWMI |
$5,497.25
|
| Rate for Payer: PHP Medicare Advantage |
$5,497.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,971.76
|
| Rate for Payer: Priority Health Medicare |
$5,497.25
|
| Rate for Payer: Priority Health Narrow Network |
$7,977.41
|
| Rate for Payer: Railroad Medicare Medicare |
$5,497.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,600.00
|
| Rate for Payer: UHC Core |
$6,504.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,497.25
|
| Rate for Payer: UHC Exchange |
$6,966.37
|
| Rate for Payer: UHC Medicare Advantage |
$5,662.17
|
| Rate for Payer: VA VA |
$5,497.25
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL ALVEOLAR LAVAGE
|
Facility
OP
|
$4,658.40
|
|
|
Service Code
|
CPT 31624
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$128.36 |
| Max. Negotiated Rate |
$4,658.40 |
| Rate for Payer: Aetna Medicare |
$1,570.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,887.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,887.76
|
| Rate for Payer: BCBS Complete |
$867.46
|
| Rate for Payer: BCBS MAPPO |
$1,510.21
|
| Rate for Payer: BCBS Trust/PPO |
$971.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,510.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,510.21
|
| Rate for Payer: Mclaren Medicaid |
$826.08
|
| Rate for Payer: Mclaren Medicare |
$1,510.21
|
| Rate for Payer: Meridian Medicaid |
$867.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,585.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,736.74
|
| Rate for Payer: PACE Medicare |
$1,434.70
|
| Rate for Payer: PACE SWMI |
$1,510.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,510.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$826.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,658.40
|
| Rate for Payer: Priority Health Medicare |
$1,510.21
|
| Rate for Payer: Priority Health Narrow Network |
$3,726.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,510.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.20
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,510.21
|
| Rate for Payer: UHC Exchange |
$128.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,555.52
|
| Rate for Payer: VA VA |
$1,510.21
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL OR ENDOBRONCHIAL BIOPSY(S), SINGLE OR MULTIPLE SITES
|
Facility
OP
|
$4,658.40
|
|
|
Service Code
|
CPT 31625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$149.97 |
| Max. Negotiated Rate |
$4,658.40 |
| Rate for Payer: Aetna Medicare |
$1,570.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,887.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,887.76
|
| Rate for Payer: BCBS Complete |
$867.46
|
| Rate for Payer: BCBS MAPPO |
$1,510.21
|
| Rate for Payer: BCBS Trust/PPO |
$905.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,510.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,510.21
|
| Rate for Payer: Mclaren Medicaid |
$826.08
|
| Rate for Payer: Mclaren Medicare |
$1,510.21
|
| Rate for Payer: Meridian Medicaid |
$867.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,585.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,736.74
|
| Rate for Payer: PACE Medicare |
$1,434.70
|
| Rate for Payer: PACE SWMI |
$1,510.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,510.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$826.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,658.40
|
| Rate for Payer: Priority Health Medicare |
$1,510.21
|
| Rate for Payer: Priority Health Narrow Network |
$3,726.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,510.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.97
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,510.21
|
| Rate for Payer: UHC Exchange |
$149.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,555.52
|
| Rate for Payer: VA VA |
$1,510.21
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRUSHING OR PROTECTED BRUSHINGS
|
Facility
OP
|
$4,658.40
|
|
|
Service Code
|
CPT 31623
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$126.72 |
| Max. Negotiated Rate |
$4,658.40 |
| Rate for Payer: Aetna Medicare |
$1,570.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,887.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,887.76
|
| Rate for Payer: BCBS Complete |
$867.46
|
| Rate for Payer: BCBS MAPPO |
$1,510.21
|
| Rate for Payer: BCBS Trust/PPO |
$935.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,510.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,510.21
|
| Rate for Payer: Mclaren Medicaid |
$826.08
|
| Rate for Payer: Mclaren Medicare |
$1,510.21
|
| Rate for Payer: Meridian Medicaid |
$867.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,585.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,736.74
|
| Rate for Payer: PACE Medicare |
$1,434.70
|
| Rate for Payer: PACE SWMI |
$1,510.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,510.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$826.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,658.40
|
| Rate for Payer: Priority Health Medicare |
$1,510.21
|
| Rate for Payer: Priority Health Narrow Network |
$3,726.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,510.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.39
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,510.21
|
| Rate for Payer: UHC Exchange |
$126.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,555.52
|
| Rate for Payer: VA VA |
$1,510.21
|
|
