|
BACLOFEN 5 MG TABLET
|
Facility
|
OP
|
$6.68
|
|
|
Service Code
|
NDC 50268010511
|
| Hospital Charge Code |
186653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna Commercial |
$5.68
|
| Rate for Payer: Aetna Medicare |
$3.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.34
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cofinity Advantage |
$4.68
|
| Rate for Payer: Cofinity Commercial |
$5.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.34
|
| Rate for Payer: Healthscope Commercial |
$6.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.01
|
| Rate for Payer: PHP Commercial |
$5.68
|
| Rate for Payer: Priority Health SBD |
$4.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.34
|
| Rate for Payer: UHC Core |
$3.48
|
| Rate for Payer: UHC Exchange |
$2.63
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$14,231.60
|
|
|
Service Code
|
APR-DRG 0493
|
| Min. Negotiated Rate |
$13,553.90 |
| Max. Negotiated Rate |
$14,231.60 |
| Rate for Payer: BCBS Complete |
$14,231.60
|
| Rate for Payer: Mclaren Medicaid |
$13,553.90
|
| Rate for Payer: Meridian Medicaid |
$14,231.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,553.90
|
| Rate for Payer: UHC Medicaid |
$13,553.90
|
| Rate for Payer: UHCCP Medicaid |
$13,553.90
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$9,462.89
|
|
|
Service Code
|
APR-DRG 0491
|
| Min. Negotiated Rate |
$9,012.28 |
| Max. Negotiated Rate |
$9,462.89 |
| Rate for Payer: BCBS Complete |
$9,462.89
|
| Rate for Payer: Mclaren Medicaid |
$9,012.28
|
| Rate for Payer: Meridian Medicaid |
$9,462.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,012.28
|
| Rate for Payer: UHC Medicaid |
$9,012.28
|
| Rate for Payer: UHCCP Medicaid |
$9,012.28
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$18,300.88
|
|
|
Service Code
|
APR-DRG 0494
|
| Min. Negotiated Rate |
$17,429.41 |
| Max. Negotiated Rate |
$18,300.88 |
| Rate for Payer: BCBS Complete |
$18,300.88
|
| Rate for Payer: Mclaren Medicaid |
$17,429.41
|
| Rate for Payer: Meridian Medicaid |
$18,300.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,429.41
|
| Rate for Payer: UHC Medicaid |
$17,429.41
|
| Rate for Payer: UHCCP Medicaid |
$17,429.41
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$9,962.81
|
|
|
Service Code
|
APR-DRG 0492
|
| Min. Negotiated Rate |
$9,488.39 |
| Max. Negotiated Rate |
$9,962.81 |
| Rate for Payer: BCBS Complete |
$9,962.81
|
| Rate for Payer: Mclaren Medicaid |
$9,488.39
|
| Rate for Payer: Meridian Medicaid |
$9,962.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,488.39
|
| Rate for Payer: UHC Medicaid |
$9,488.39
|
| Rate for Payer: UHCCP Medicaid |
$9,488.39
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC
|
Facility
|
IP
|
$57,993.32
|
|
|
Service Code
|
MSDRG 095
|
| Min. Negotiated Rate |
$19,486.06 |
| Max. Negotiated Rate |
$57,993.32 |
| Rate for Payer: Aetna Medicare |
$21,332.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,639.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,639.55
|
| Rate for Payer: BCBS MAPPO |
$20,511.64
|
| Rate for Payer: BCBS Trust/PPO |
$57,993.32
|
| Rate for Payer: BCN Commercial |
$57,993.32
|
| Rate for Payer: BCN Medicare Advantage |
$20,511.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,511.64
|
| Rate for Payer: Mclaren Medicare |
$20,511.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,537.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,588.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,562.80
|
| Rate for Payer: Nomi Health Commercial |
$33,271.68
|
| Rate for Payer: PACE Medicare |
$19,486.06
|
| Rate for Payer: PACE SWMI |
$20,511.64
|
| Rate for Payer: PHP Medicare Advantage |
$20,511.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,582.22
|
| Rate for Payer: Priority Health Medicare |
$20,511.64
|
| Rate for Payer: Priority Health Tiered Network |
$33,265.77
|
| Rate for Payer: Railroad Medicare Medicare |
$20,511.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42,040.96
|
| Rate for Payer: UHC Core |
$35,172.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,511.64
|
| Rate for Payer: UHC Exchange |
$28,724.55
|
| Rate for Payer: VA VA |
$20,511.64
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC
|
Facility
|
IP
|
$68,440.31
|
|
|
Service Code
|
MSDRG 094
|
| Min. Negotiated Rate |
$26,388.85 |
| Max. Negotiated Rate |
$68,440.31 |
| Rate for Payer: Aetna Medicare |
$28,888.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,722.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,722.18
|
| Rate for Payer: BCBS MAPPO |
$27,777.74
|
| Rate for Payer: BCBS Trust/PPO |
$68,440.31
|
| Rate for Payer: BCN Commercial |
$68,440.31
|
| Rate for Payer: BCN Medicare Advantage |
$27,777.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,777.74
|
| Rate for Payer: Mclaren Medicare |
$27,777.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,166.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,944.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$30,555.51
|
| Rate for Payer: Nomi Health Commercial |
$45,400.26
|
| Rate for Payer: PACE Medicare |
$26,388.85
|
| Rate for Payer: PACE SWMI |
$27,777.74
|
| Rate for Payer: PHP Medicare Advantage |
$27,777.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$56,740.26
|
| Rate for Payer: Priority Health Medicare |
$27,777.74
|
| Rate for Payer: Priority Health Tiered Network |
$45,392.20
|
| Rate for Payer: Railroad Medicare Medicare |
$27,777.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57,366.22
|
| Rate for Payer: UHC Core |
$47,994.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27,777.74
|
| Rate for Payer: UHC Exchange |
$39,195.56
|
| Rate for Payer: VA VA |
$27,777.74
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC
|
Facility
|
IP
|
$42,040.96
|
|
|
Service Code
|
MSDRG 096
|
| Min. Negotiated Rate |
$19,486.06 |
| Max. Negotiated Rate |
$42,040.96 |
| Rate for Payer: Aetna Medicare |
$21,332.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,639.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,639.55
|
| Rate for Payer: BCBS MAPPO |
$20,511.64
|
| Rate for Payer: BCBS Trust/PPO |
$40,725.24
|
| Rate for Payer: BCN Commercial |
$40,725.24
|
| Rate for Payer: BCN Medicare Advantage |
$20,511.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,511.64
|
| Rate for Payer: Mclaren Medicare |
$20,511.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,537.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,588.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,562.80
|
| Rate for Payer: Nomi Health Commercial |
$33,271.68
|
| Rate for Payer: PACE Medicare |
$19,486.06
|
| Rate for Payer: PACE SWMI |
$20,511.64
|
| Rate for Payer: PHP Medicare Advantage |
$20,511.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,582.22
|
| Rate for Payer: Priority Health Medicare |
$20,511.64
|
| Rate for Payer: Priority Health Tiered Network |
$33,265.77
|
| Rate for Payer: Railroad Medicare Medicare |
$20,511.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42,040.96
|
| Rate for Payer: UHC Core |
$35,172.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,511.64
|
| Rate for Payer: UHC Exchange |
$28,724.55
|
| Rate for Payer: VA VA |
$20,511.64
|
|
|
BARICITINIB 2 MG TABLET
|
Facility
|
OP
|
$9,736.26
|
|
|
Service Code
|
NDC 00002418230
|
| Hospital Charge Code |
186973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,826.35 |
| Max. Negotiated Rate |
$8,762.63 |
| Rate for Payer: Aetna Commercial |
$8,275.82
|
| Rate for Payer: Aetna Medicare |
$4,868.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,328.57
|
| Rate for Payer: BCBS Complete |
$3,894.50
|
| Rate for Payer: Cash Price |
$7,789.01
|
| Rate for Payer: Cofinity Advantage |
$6,815.38
|
| Rate for Payer: Cofinity Commercial |
$8,373.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,789.01
|
| Rate for Payer: Healthscope Commercial |
$8,762.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,789.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,275.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,302.19
|
| Rate for Payer: PHP Commercial |
$8,275.82
|
| Rate for Payer: Priority Health SBD |
$6,133.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,328.57
|
| Rate for Payer: UHC Core |
$5,072.59
|
| Rate for Payer: UHC Exchange |
$3,826.35
|
|
|
BARICITINIB 2 MG TABLET
|
Facility
|
IP
|
$9,736.26
|
|
|
Service Code
|
NDC 00002418230
|
| Hospital Charge Code |
186973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6,133.84 |
| Max. Negotiated Rate |
$8,762.63 |
| Rate for Payer: Aetna Commercial |
$8,275.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,328.57
|
| Rate for Payer: Cash Price |
$7,789.01
|
| Rate for Payer: Cofinity Advantage |
$6,815.38
|
| Rate for Payer: Cofinity Commercial |
$8,373.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,789.01
|
| Rate for Payer: Healthscope Commercial |
$8,762.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,275.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,302.19
|
| Rate for Payer: PHP Commercial |
$8,275.82
|
| Rate for Payer: Priority Health SBD |
$6,133.84
|
|
|
BARIUM SULFATE (BULK) POWDER
|
Facility
|
IP
|
$681.00
|
|
|
Service Code
|
NDC 00395020001
|
| Hospital Charge Code |
916
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$429.03 |
| Max. Negotiated Rate |
$612.90 |
| Rate for Payer: Aetna Commercial |
$578.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$442.65
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cofinity Advantage |
$476.70
|
| Rate for Payer: Cofinity Commercial |
$585.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.80
|
| Rate for Payer: Healthscope Commercial |
$612.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$578.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$510.75
|
| Rate for Payer: PHP Commercial |
$578.85
|
| Rate for Payer: Priority Health SBD |
$429.03
|
|
|
BARIUM SULFATE (BULK) POWDER
|
Facility
|
OP
|
$681.00
|
|
|
Service Code
|
NDC 00395020001
|
| Hospital Charge Code |
916
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$272.40 |
| Max. Negotiated Rate |
$612.90 |
| Rate for Payer: Aetna Commercial |
$578.85
|
| Rate for Payer: Aetna Medicare |
$340.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$442.65
|
| Rate for Payer: BCBS Complete |
$272.40
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cofinity Advantage |
$476.70
|
| Rate for Payer: Cofinity Commercial |
$585.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.80
|
| Rate for Payer: Healthscope Commercial |
$612.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$544.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$578.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$510.75
|
| Rate for Payer: PHP Commercial |
$578.85
|
| Rate for Payer: Priority Health SBD |
$429.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$340.50
|
| Rate for Payer: UHC Core |
$340.50
|
| Rate for Payer: UHC Exchange |
$340.50
|
|
|
BBC JOINT COCKTAIL COMPOUND (INTRA-OP)
|
Facility
|
IP
|
$283.83
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
300231
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$178.81 |
| Max. Negotiated Rate |
$255.45 |
| Rate for Payer: Aetna Commercial |
$241.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.49
|
| Rate for Payer: Cash Price |
$227.06
|
| Rate for Payer: Cofinity Advantage |
$198.68
|
| Rate for Payer: Cofinity Commercial |
$244.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.06
|
| Rate for Payer: Healthscope Commercial |
$255.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.87
|
| Rate for Payer: PHP Commercial |
$241.26
|
| Rate for Payer: Priority Health SBD |
$178.81
|
|
|
BBC JOINT COCKTAIL COMPOUND (INTRA-OP)
|
Facility
|
OP
|
$283.83
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
300231
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$255.45 |
| Rate for Payer: Aetna Commercial |
$241.26
|
| Rate for Payer: Aetna Medicare |
$141.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.49
|
| Rate for Payer: BCBS Complete |
$113.53
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$227.06
|
| Rate for Payer: Cash Price |
$227.06
|
| Rate for Payer: Cofinity Advantage |
$198.68
|
| Rate for Payer: Cofinity Commercial |
$244.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.06
|
| Rate for Payer: Healthscope Commercial |
$255.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.87
|
| Rate for Payer: PHP Commercial |
$241.26
|
| Rate for Payer: Priority Health SBD |
$178.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
|
|
BBC JOINT COCKTAIL COMPOUND WITHOUT KETOROLAC (INTRA-OP)
|
Facility
|
OP
|
$283.83
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
300230
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$255.45 |
| Rate for Payer: Aetna Commercial |
$241.26
|
| Rate for Payer: Aetna Medicare |
$141.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.49
|
| Rate for Payer: BCBS Complete |
$113.53
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$227.06
|
| Rate for Payer: Cash Price |
$227.06
|
| Rate for Payer: Cofinity Advantage |
$198.68
|
| Rate for Payer: Cofinity Commercial |
$244.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.06
|
| Rate for Payer: Healthscope Commercial |
$255.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.87
|
| Rate for Payer: PHP Commercial |
$241.26
|
| Rate for Payer: Priority Health SBD |
$178.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
|
|
BBC JOINT COCKTAIL COMPOUND WITHOUT KETOROLAC (INTRA-OP)
|
Facility
|
IP
|
$283.83
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
300230
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$178.81 |
| Max. Negotiated Rate |
$255.45 |
| Rate for Payer: Aetna Commercial |
$241.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.49
|
| Rate for Payer: Cash Price |
$227.06
|
| Rate for Payer: Cofinity Advantage |
$198.68
|
| Rate for Payer: Cofinity Commercial |
$244.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.06
|
| Rate for Payer: Healthscope Commercial |
$255.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.87
|
| Rate for Payer: PHP Commercial |
$241.26
|
| Rate for Payer: Priority Health SBD |
$178.81
|
|
|
BCG LIVE 50 MG INTRAVESICAL SUSPENSION
|
Facility
|
IP
|
$522.78
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
116210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$329.35 |
| Max. Negotiated Rate |
$470.50 |
| Rate for Payer: Aetna Commercial |
$444.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.81
|
| Rate for Payer: Cash Price |
$418.22
|
| Rate for Payer: Cofinity Advantage |
$365.95
|
| Rate for Payer: Cofinity Commercial |
$449.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.22
|
| Rate for Payer: Healthscope Commercial |
$470.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$392.08
|
| Rate for Payer: PHP Commercial |
$444.36
|
| Rate for Payer: Priority Health SBD |
$329.35
|
|
|
BCG LIVE 50 MG INTRAVESICAL SUSPENSION
|
Facility
|
OP
|
$522.78
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
116210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$470.50 |
| Rate for Payer: Aetna Commercial |
$444.36
|
| Rate for Payer: Aetna Medicare |
$3.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.24
|
| Rate for Payer: BCBS Complete |
$1.86
|
| Rate for Payer: BCBS MAPPO |
$3.39
|
| Rate for Payer: BCBS Trust/PPO |
$8.22
|
| Rate for Payer: BCN Commercial |
$8.22
|
| Rate for Payer: BCN Medicare Advantage |
$3.39
|
| Rate for Payer: Cash Price |
$418.22
|
| Rate for Payer: Cash Price |
$418.22
|
| Rate for Payer: Cofinity Advantage |
$365.95
|
| Rate for Payer: Cofinity Commercial |
$449.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$470.50
|
| Rate for Payer: Mclaren Medicaid |
$1.77
|
| Rate for Payer: Mclaren Medicare |
$3.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.56
|
| Rate for Payer: Meridian Medicaid |
$3.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.36
|
| Rate for Payer: Nomi Health Commercial |
$10.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$392.08
|
| Rate for Payer: PACE Medicare |
$3.22
|
| Rate for Payer: PACE SWMI |
$3.39
|
| Rate for Payer: PHP Commercial |
$444.36
|
| Rate for Payer: PHP Medicare Advantage |
$3.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10.29
|
| Rate for Payer: Priority Health Medicare |
$3.39
|
| Rate for Payer: Priority Health SBD |
$329.35
|
| Rate for Payer: Priority Health Tiered Network |
$8.23
|
| Rate for Payer: Railroad Medicare Medicare |
$3.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.41
|
| Rate for Payer: UHC Core |
$5.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.39
|
| Rate for Payer: UHC Exchange |
$5.41
|
| Rate for Payer: UHC Medicaid |
$1.77
|
| Rate for Payer: UHCCP Medicaid |
$1.77
|
| Rate for Payer: VA VA |
$3.39
|
|
|
BEHAVIORAL AND DEVELOPMENTAL DISORDERS
|
Facility
|
IP
|
$33,827.39
|
|
|
Service Code
|
MSDRG 886
|
| Min. Negotiated Rate |
$1,069.00 |
| Max. Negotiated Rate |
$33,827.39 |
| Rate for Payer: Aetna Medicare |
$17,282.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,771.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,771.74
|
| Rate for Payer: BCBS MAPPO |
$16,617.39
|
| Rate for Payer: BCBS Trust/PPO |
$20,074.70
|
| Rate for Payer: BCN Commercial |
$20,074.70
|
| Rate for Payer: BCN Medicare Advantage |
$16,617.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,617.39
|
| Rate for Payer: Mclaren Medicare |
$16,617.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,448.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,110.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,279.13
|
| Rate for Payer: Nomi Health Commercial |
$1,069.00
|
| Rate for Payer: PACE Medicare |
$15,786.52
|
| Rate for Payer: PACE SWMI |
$16,617.39
|
| Rate for Payer: PHP Medicare Advantage |
$16,617.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,458.28
|
| Rate for Payer: Priority Health Medicare |
$16,617.39
|
| Rate for Payer: Priority Health Tiered Network |
$26,766.62
|
| Rate for Payer: Railroad Medicare Medicare |
$16,617.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,827.39
|
| Rate for Payer: UHC Core |
$28,300.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,617.39
|
| Rate for Payer: UHC Exchange |
$23,112.62
|
| Rate for Payer: VA VA |
$16,617.39
|
|
|
BELATACEPT 250 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,948.45
|
|
|
Service Code
|
HCPCS J0485
|
| Hospital Charge Code |
152968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$2,653.61 |
| Rate for Payer: Aetna Commercial |
$2,506.18
|
| Rate for Payer: Aetna Medicare |
$4.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,916.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.86
|
| Rate for Payer: BCBS Complete |
$2.14
|
| Rate for Payer: BCBS MAPPO |
$3.89
|
| Rate for Payer: BCBS Trust/PPO |
$9.75
|
| Rate for Payer: BCN Commercial |
$9.75
|
| Rate for Payer: BCN Medicare Advantage |
$3.89
|
| Rate for Payer: Cash Price |
$2,358.76
|
| Rate for Payer: Cash Price |
$2,358.76
|
| Rate for Payer: Cofinity Advantage |
$2,063.91
|
| Rate for Payer: Cofinity Commercial |
$2,535.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,358.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.89
|
| Rate for Payer: Healthscope Commercial |
$2,653.61
|
| Rate for Payer: Mclaren Medicaid |
$2.03
|
| Rate for Payer: Mclaren Medicare |
$3.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.08
|
| Rate for Payer: Meridian Medicaid |
$4.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,506.18
|
| Rate for Payer: Nomi Health Commercial |
$11.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,211.34
|
| Rate for Payer: PACE Medicare |
$3.70
|
| Rate for Payer: PACE SWMI |
$3.89
|
| Rate for Payer: PHP Commercial |
$2,506.18
|
| Rate for Payer: PHP Medicare Advantage |
$3.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.25
|
| Rate for Payer: Priority Health Medicare |
$3.89
|
| Rate for Payer: Priority Health SBD |
$1,857.52
|
| Rate for Payer: Priority Health Tiered Network |
$9.80
|
| Rate for Payer: Railroad Medicare Medicare |
$3.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.42
|
| Rate for Payer: UHC Core |
$6.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.89
|
| Rate for Payer: UHC Exchange |
$6.42
|
| Rate for Payer: UHC Medicaid |
$2.03
|
| Rate for Payer: UHCCP Medicaid |
$2.03
|
| Rate for Payer: VA VA |
$3.89
|
|
|
BELATACEPT 250 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,948.45
|
|
|
Service Code
|
HCPCS J0485
|
| Hospital Charge Code |
152968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,857.52 |
| Max. Negotiated Rate |
$2,653.61 |
| Rate for Payer: Aetna Commercial |
$2,506.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,916.49
|
| Rate for Payer: Cash Price |
$2,358.76
|
| Rate for Payer: Cofinity Advantage |
$2,063.91
|
| Rate for Payer: Cofinity Commercial |
$2,535.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,358.76
|
| Rate for Payer: Healthscope Commercial |
$2,653.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,506.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,211.34
|
| Rate for Payer: PHP Commercial |
$2,506.18
|
| Rate for Payer: Priority Health SBD |
$1,857.52
|
|
|
BELIMUMAB 120 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,113.28
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
152250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.91 |
| Max. Negotiated Rate |
$1,901.95 |
| Rate for Payer: Aetna Commercial |
$1,796.29
|
| Rate for Payer: Aetna Medicare |
$59.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,373.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.49
|
| Rate for Payer: BCBS Complete |
$31.41
|
| Rate for Payer: BCBS MAPPO |
$57.19
|
| Rate for Payer: BCBS Trust/PPO |
$143.39
|
| Rate for Payer: BCN Commercial |
$143.39
|
| Rate for Payer: BCN Medicare Advantage |
$57.19
|
| Rate for Payer: Cash Price |
$1,690.62
|
| Rate for Payer: Cash Price |
$1,690.62
|
| Rate for Payer: Cofinity Advantage |
$1,479.30
|
| Rate for Payer: Cofinity Commercial |
$1,817.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,690.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.19
|
| Rate for Payer: Healthscope Commercial |
$1,901.95
|
| Rate for Payer: Mclaren Medicaid |
$29.91
|
| Rate for Payer: Mclaren Medicare |
$57.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.05
|
| Rate for Payer: Meridian Medicaid |
$60.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,796.29
|
| Rate for Payer: Nomi Health Commercial |
$171.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,584.96
|
| Rate for Payer: PACE Medicare |
$54.33
|
| Rate for Payer: PACE SWMI |
$57.19
|
| Rate for Payer: PHP Commercial |
$1,796.29
|
| Rate for Payer: PHP Medicare Advantage |
$57.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$176.83
|
| Rate for Payer: Priority Health Medicare |
$57.19
|
| Rate for Payer: Priority Health SBD |
$1,331.37
|
| Rate for Payer: Priority Health Tiered Network |
$141.46
|
| Rate for Payer: Railroad Medicare Medicare |
$57.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.31
|
| Rate for Payer: UHC Core |
$94.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$57.19
|
| Rate for Payer: UHC Exchange |
$94.31
|
| Rate for Payer: UHC Medicaid |
$29.91
|
| Rate for Payer: UHCCP Medicaid |
$29.91
|
| Rate for Payer: VA VA |
$57.19
|
|
|
BELIMUMAB 120 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,113.28
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
152250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,331.37 |
| Max. Negotiated Rate |
$1,901.95 |
| Rate for Payer: Aetna Commercial |
$1,796.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,373.63
|
| Rate for Payer: Cash Price |
$1,690.62
|
| Rate for Payer: Cofinity Advantage |
$1,479.30
|
| Rate for Payer: Cofinity Commercial |
$1,817.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,690.62
|
| Rate for Payer: Healthscope Commercial |
$1,901.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,796.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,584.96
|
| Rate for Payer: PHP Commercial |
$1,796.29
|
| Rate for Payer: Priority Health SBD |
$1,331.37
|
|
|
BELIMUMAB 400 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,723.05
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
152251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,605.52 |
| Max. Negotiated Rate |
$5,150.74 |
| Rate for Payer: Aetna Commercial |
$4,864.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,719.98
|
| Rate for Payer: Cash Price |
$4,578.44
|
| Rate for Payer: Cofinity Advantage |
$4,006.14
|
| Rate for Payer: Cofinity Commercial |
$4,921.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,578.44
|
| Rate for Payer: Healthscope Commercial |
$5,150.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,864.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,292.29
|
| Rate for Payer: PHP Commercial |
$4,864.59
|
| Rate for Payer: Priority Health SBD |
$3,605.52
|
|
|
BELIMUMAB 400 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,723.05
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
152251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.91 |
| Max. Negotiated Rate |
$5,150.74 |
| Rate for Payer: Aetna Commercial |
$4,864.59
|
| Rate for Payer: Aetna Medicare |
$59.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,719.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.49
|
| Rate for Payer: BCBS Complete |
$31.41
|
| Rate for Payer: BCBS MAPPO |
$57.19
|
| Rate for Payer: BCBS Trust/PPO |
$143.39
|
| Rate for Payer: BCN Commercial |
$143.39
|
| Rate for Payer: BCN Medicare Advantage |
$57.19
|
| Rate for Payer: Cash Price |
$4,578.44
|
| Rate for Payer: Cash Price |
$4,578.44
|
| Rate for Payer: Cofinity Advantage |
$4,006.14
|
| Rate for Payer: Cofinity Commercial |
$4,921.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,578.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.19
|
| Rate for Payer: Healthscope Commercial |
$5,150.74
|
| Rate for Payer: Mclaren Medicaid |
$29.91
|
| Rate for Payer: Mclaren Medicare |
$57.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.05
|
| Rate for Payer: Meridian Medicaid |
$60.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,864.59
|
| Rate for Payer: Nomi Health Commercial |
$171.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,292.29
|
| Rate for Payer: PACE Medicare |
$54.33
|
| Rate for Payer: PACE SWMI |
$57.19
|
| Rate for Payer: PHP Commercial |
$4,864.59
|
| Rate for Payer: PHP Medicare Advantage |
$57.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$176.83
|
| Rate for Payer: Priority Health Medicare |
$57.19
|
| Rate for Payer: Priority Health SBD |
$3,605.52
|
| Rate for Payer: Priority Health Tiered Network |
$141.46
|
| Rate for Payer: Railroad Medicare Medicare |
$57.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.31
|
| Rate for Payer: UHC Core |
$94.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$57.19
|
| Rate for Payer: UHC Exchange |
$94.31
|
| Rate for Payer: UHC Medicaid |
$29.91
|
| Rate for Payer: UHCCP Medicaid |
$29.91
|
| Rate for Payer: VA VA |
$57.19
|
|
