|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$415.95
|
|
|
Service Code
|
NDC 52817027010
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.05 |
| Max. Negotiated Rate |
$374.36 |
| Rate for Payer: Aetna Commercial |
$353.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.37
|
| Rate for Payer: Cash Price |
$332.76
|
| Rate for Payer: Cofinity Advantage |
$291.17
|
| Rate for Payer: Cofinity Commercial |
$357.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.76
|
| Rate for Payer: Healthscope Commercial |
$374.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$311.96
|
| Rate for Payer: PHP Commercial |
$353.56
|
| Rate for Payer: Priority Health SBD |
$262.05
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$228.24
|
|
|
Service Code
|
NDC 50268012715
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.70 |
| Max. Negotiated Rate |
$205.42 |
| Rate for Payer: Aetna Commercial |
$194.00
|
| Rate for Payer: Aetna Medicare |
$114.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.36
|
| Rate for Payer: BCBS Complete |
$91.30
|
| Rate for Payer: Cash Price |
$182.59
|
| Rate for Payer: Cofinity Advantage |
$159.77
|
| Rate for Payer: Cofinity Commercial |
$196.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.59
|
| Rate for Payer: Healthscope Commercial |
$205.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.18
|
| Rate for Payer: PHP Commercial |
$194.00
|
| Rate for Payer: Priority Health SBD |
$143.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.36
|
| Rate for Payer: UHC Core |
$118.91
|
| Rate for Payer: UHC Exchange |
$89.70
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$5.81
|
|
|
Service Code
|
NDC 60687067911
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: Aetna Medicare |
$2.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.78
|
| Rate for Payer: BCBS Complete |
$2.32
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Cofinity Advantage |
$4.07
|
| Rate for Payer: Cofinity Commercial |
$5.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.65
|
| Rate for Payer: Healthscope Commercial |
$5.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.36
|
| Rate for Payer: PHP Commercial |
$4.94
|
| Rate for Payer: Priority Health SBD |
$3.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.78
|
| Rate for Payer: UHC Core |
$3.03
|
| Rate for Payer: UHC Exchange |
$2.28
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$4.57
|
|
|
Service Code
|
NDC 50268012711
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: Aetna Medicare |
$2.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.97
|
| Rate for Payer: BCBS Complete |
$1.83
|
| Rate for Payer: Cash Price |
$3.66
|
| Rate for Payer: Cofinity Advantage |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$3.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.66
|
| Rate for Payer: Healthscope Commercial |
$4.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.43
|
| Rate for Payer: PHP Commercial |
$3.88
|
| Rate for Payer: Priority Health SBD |
$2.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.97
|
| Rate for Payer: UHC Core |
$2.38
|
| Rate for Payer: UHC Exchange |
$1.80
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$228.24
|
|
|
Service Code
|
NDC 50268012715
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.79 |
| Max. Negotiated Rate |
$205.42 |
| Rate for Payer: Aetna Commercial |
$194.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.36
|
| Rate for Payer: Cash Price |
$182.59
|
| Rate for Payer: Cofinity Advantage |
$159.77
|
| Rate for Payer: Cofinity Commercial |
$196.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.59
|
| Rate for Payer: Healthscope Commercial |
$205.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.18
|
| Rate for Payer: PHP Commercial |
$194.00
|
| Rate for Payer: Priority Health SBD |
$143.79
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$415.95
|
|
|
Service Code
|
NDC 52817027010
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.47 |
| Max. Negotiated Rate |
$374.36 |
| Rate for Payer: Aetna Commercial |
$353.56
|
| Rate for Payer: Aetna Medicare |
$207.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.37
|
| Rate for Payer: BCBS Complete |
$166.38
|
| Rate for Payer: Cash Price |
$332.76
|
| Rate for Payer: Cofinity Advantage |
$291.17
|
| Rate for Payer: Cofinity Commercial |
$357.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.76
|
| Rate for Payer: Healthscope Commercial |
$374.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$311.96
|
| Rate for Payer: PHP Commercial |
$353.56
|
| Rate for Payer: Priority Health SBD |
$262.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.37
|
| Rate for Payer: UHC Core |
$216.71
|
| Rate for Payer: UHC Exchange |
$163.47
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$5.81
|
|
|
Service Code
|
NDC 60687067911
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.78
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Cofinity Advantage |
$4.07
|
| Rate for Payer: Cofinity Commercial |
$5.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.65
|
| Rate for Payer: Healthscope Commercial |
$5.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.36
|
| Rate for Payer: PHP Commercial |
$4.94
|
| Rate for Payer: Priority Health SBD |
$3.66
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$4.57
|
|
|
Service Code
|
NDC 50268012711
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.97
|
| Rate for Payer: Cash Price |
$3.66
|
| Rate for Payer: Cofinity Advantage |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$3.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.66
|
| Rate for Payer: Healthscope Commercial |
$4.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.43
|
| Rate for Payer: PHP Commercial |
$3.88
|
| Rate for Payer: Priority Health SBD |
$2.88
|
|
|
BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT (INCLUDING RETENTION TIME)
|
Facility
|
OP
|
$2,246.88
|
|
|
Service Code
|
CPT 51720
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$363.38 |
| Max. Negotiated Rate |
$2,246.88 |
| Rate for Payer: Aetna Medicare |
$722.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$868.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$868.49
|
| Rate for Payer: BCBS Complete |
$381.58
|
| Rate for Payer: BCBS MAPPO |
$694.79
|
| Rate for Payer: BCBS Trust/PPO |
$515.59
|
| Rate for Payer: BCN Commercial |
$515.59
|
| Rate for Payer: BCN Medicare Advantage |
$694.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.79
|
| Rate for Payer: Mclaren Medicaid |
$363.38
|
| Rate for Payer: Mclaren Medicare |
$694.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.53
|
| Rate for Payer: Meridian Medicaid |
$729.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$799.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$764.27
|
| Rate for Payer: Nomi Health Commercial |
$2,084.37
|
| Rate for Payer: PACE Medicare |
$660.05
|
| Rate for Payer: PACE SWMI |
$694.79
|
| Rate for Payer: PHP Medicare Advantage |
$694.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,246.88
|
| Rate for Payer: Priority Health Medicare |
$694.79
|
| Rate for Payer: Priority Health Tiered Network |
$1,797.50
|
| Rate for Payer: Railroad Medicare Medicare |
$694.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$694.79
|
| Rate for Payer: UHC Medicaid |
$363.38
|
| Rate for Payer: UHCCP Medicaid |
$363.38
|
| Rate for Payer: VA VA |
$694.79
|
|
|
BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$274.29
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
9289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.98 |
| Max. Negotiated Rate |
$246.86 |
| Rate for Payer: Aetna Commercial |
$233.15
|
| Rate for Payer: Aetna Commercial |
$408.44
|
| Rate for Payer: Aetna Commercial |
$418.29
|
| Rate for Payer: Aetna Medicare |
$137.15
|
| Rate for Payer: Aetna Medicare |
$240.26
|
| Rate for Payer: Aetna Medicare |
$246.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.29
|
| Rate for Payer: BCBS Complete |
$109.72
|
| Rate for Payer: BCBS Complete |
$192.21
|
| Rate for Payer: BCBS Complete |
$196.84
|
| Rate for Payer: BCBS Trust/PPO |
$56.66
|
| Rate for Payer: BCBS Trust/PPO |
$56.66
|
| Rate for Payer: BCBS Trust/PPO |
$56.66
|
| Rate for Payer: BCN Commercial |
$56.66
|
| Rate for Payer: BCN Commercial |
$56.66
|
| Rate for Payer: BCN Commercial |
$56.66
|
| Rate for Payer: Cash Price |
$393.68
|
| Rate for Payer: Cash Price |
$219.43
|
| Rate for Payer: Cash Price |
$219.43
|
| Rate for Payer: Cash Price |
$384.42
|
| Rate for Payer: Cash Price |
$393.68
|
| Rate for Payer: Cash Price |
$384.42
|
| Rate for Payer: Cofinity Advantage |
$336.36
|
| Rate for Payer: Cofinity Advantage |
$192.00
|
| Rate for Payer: Cofinity Advantage |
$344.47
|
| Rate for Payer: Cofinity Commercial |
$413.25
|
| Rate for Payer: Cofinity Commercial |
$235.89
|
| Rate for Payer: Cofinity Commercial |
$423.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.42
|
| Rate for Payer: Healthscope Commercial |
$442.89
|
| Rate for Payer: Healthscope Commercial |
$246.86
|
| Rate for Payer: Healthscope Commercial |
$432.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$384.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$360.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$369.07
|
| Rate for Payer: PHP Commercial |
$233.15
|
| Rate for Payer: PHP Commercial |
$408.44
|
| Rate for Payer: PHP Commercial |
$418.29
|
| Rate for Payer: Priority Health SBD |
$172.80
|
| Rate for Payer: Priority Health SBD |
$302.73
|
| Rate for Payer: Priority Health SBD |
$310.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.98
|
| Rate for Payer: UHC Core |
$37.98
|
| Rate for Payer: UHC Core |
$37.98
|
| Rate for Payer: UHC Core |
$37.98
|
| Rate for Payer: UHC Exchange |
$37.98
|
| Rate for Payer: UHC Exchange |
$37.98
|
| Rate for Payer: UHC Exchange |
$37.98
|
|
|
BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$912.70
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
17012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.66 |
| Max. Negotiated Rate |
$821.43 |
| Rate for Payer: Aetna Commercial |
$775.79
|
| Rate for Payer: Aetna Commercial |
$455.87
|
| Rate for Payer: Aetna Medicare |
$456.35
|
| Rate for Payer: Aetna Medicare |
$268.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.25
|
| Rate for Payer: BCBS Complete |
$365.08
|
| Rate for Payer: BCBS Complete |
$214.53
|
| Rate for Payer: BCBS Trust/PPO |
$56.66
|
| Rate for Payer: BCBS Trust/PPO |
$56.66
|
| Rate for Payer: BCN Commercial |
$56.66
|
| Rate for Payer: BCN Commercial |
$56.66
|
| Rate for Payer: Cash Price |
$730.16
|
| Rate for Payer: Cash Price |
$429.06
|
| Rate for Payer: Cash Price |
$730.16
|
| Rate for Payer: Cash Price |
$429.06
|
| Rate for Payer: Cofinity Advantage |
$375.42
|
| Rate for Payer: Cofinity Advantage |
$638.89
|
| Rate for Payer: Cofinity Commercial |
$784.92
|
| Rate for Payer: Cofinity Commercial |
$461.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$429.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.16
|
| Rate for Payer: Healthscope Commercial |
$821.43
|
| Rate for Payer: Healthscope Commercial |
$482.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$730.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$775.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$402.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$684.52
|
| Rate for Payer: PHP Commercial |
$775.79
|
| Rate for Payer: PHP Commercial |
$455.87
|
| Rate for Payer: Priority Health SBD |
$337.88
|
| Rate for Payer: Priority Health SBD |
$575.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$348.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$593.25
|
| Rate for Payer: UHC Core |
$279.42
|
| Rate for Payer: UHC Core |
$475.52
|
| Rate for Payer: UHC Exchange |
$210.77
|
| Rate for Payer: UHC Exchange |
$358.69
|
|
|
BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$536.32
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
17012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$337.88 |
| Max. Negotiated Rate |
$482.69 |
| Rate for Payer: Aetna Commercial |
$455.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.61
|
| Rate for Payer: Cash Price |
$429.06
|
| Rate for Payer: Cofinity Advantage |
$375.42
|
| Rate for Payer: Cofinity Commercial |
$461.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$429.06
|
| Rate for Payer: Healthscope Commercial |
$482.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$402.24
|
| Rate for Payer: PHP Commercial |
$455.87
|
| Rate for Payer: Priority Health SBD |
$337.88
|
|
|
BLEPHAROPLASTY, UPPER EYELID; WITH EXCESSIVE SKIN WEIGHTING DOWN LID
|
Facility
|
OP
|
$6,648.46
|
|
|
Service Code
|
CPT 15823
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,262.85
|
| Rate for Payer: BCN Commercial |
$1,262.85
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Mclaren Medicaid |
$1,075.21
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
BONE DISEASES AND ARTHROPATHIES WITH MCC
|
Facility
|
IP
|
$22,097.15
|
|
|
Service Code
|
MSDRG 553
|
| Min. Negotiated Rate |
$10,067.24 |
| Max. Negotiated Rate |
$22,097.15 |
| Rate for Payer: Aetna Medicare |
$11,020.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,246.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,246.36
|
| Rate for Payer: BCBS MAPPO |
$10,597.09
|
| Rate for Payer: BCBS Trust/PPO |
$22,097.15
|
| Rate for Payer: BCN Commercial |
$22,097.15
|
| Rate for Payer: BCN Medicare Advantage |
$10,597.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,597.09
|
| Rate for Payer: Mclaren Medicare |
$10,597.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,126.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,186.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,656.80
|
| Rate for Payer: Nomi Health Commercial |
$16,722.27
|
| Rate for Payer: PACE Medicare |
$10,067.24
|
| Rate for Payer: PACE SWMI |
$10,597.09
|
| Rate for Payer: PHP Medicare Advantage |
$10,597.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,899.13
|
| Rate for Payer: Priority Health Medicare |
$10,597.09
|
| Rate for Payer: Priority Health Tiered Network |
$16,719.30
|
| Rate for Payer: Railroad Medicare Medicare |
$10,597.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,129.69
|
| Rate for Payer: UHC Core |
$17,677.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,597.09
|
| Rate for Payer: UHC Exchange |
$14,436.89
|
| Rate for Payer: VA VA |
$10,597.09
|
|
|
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC
|
Facility
|
IP
|
$14,023.73
|
|
|
Service Code
|
MSDRG 554
|
| Min. Negotiated Rate |
$6,644.50 |
| Max. Negotiated Rate |
$14,023.73 |
| Rate for Payer: Aetna Medicare |
$7,273.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,742.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,742.76
|
| Rate for Payer: BCBS MAPPO |
$6,994.21
|
| Rate for Payer: BCBS Trust/PPO |
$14,023.73
|
| Rate for Payer: BCN Commercial |
$14,023.73
|
| Rate for Payer: BCN Medicare Advantage |
$6,994.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,994.21
|
| Rate for Payer: Mclaren Medicare |
$6,994.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,343.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,043.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,693.63
|
| Rate for Payer: Nomi Health Commercial |
$10,708.29
|
| Rate for Payer: PACE Medicare |
$6,644.50
|
| Rate for Payer: PACE SWMI |
$6,994.21
|
| Rate for Payer: PHP Medicare Advantage |
$6,994.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,382.99
|
| Rate for Payer: Priority Health Medicare |
$6,994.21
|
| Rate for Payer: Priority Health Tiered Network |
$10,706.39
|
| Rate for Payer: Railroad Medicare Medicare |
$6,994.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,530.63
|
| Rate for Payer: UHC Core |
$11,320.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,994.21
|
| Rate for Payer: UHC Exchange |
$9,244.82
|
| Rate for Payer: VA VA |
$6,994.21
|
|
|
BONE GRAFT, ANY DONOR AREA; MAJOR OR LARGE
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 20902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,539.27 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,539.27
|
| Rate for Payer: BCN Commercial |
$3,539.27
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$3,781.35
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
BORTEZOMIB 2.5 MG/ML SUBCUTANEOUS INJECTION
|
Facility
|
OP
|
$198.63
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
151057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$178.77 |
| Rate for Payer: Aetna Commercial |
$168.84
|
| Rate for Payer: Aetna Medicare |
$99.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.11
|
| Rate for Payer: BCBS Complete |
$79.45
|
| Rate for Payer: BCBS Trust/PPO |
$6.57
|
| Rate for Payer: BCN Commercial |
$6.57
|
| Rate for Payer: Cash Price |
$158.90
|
| Rate for Payer: Cash Price |
$158.90
|
| Rate for Payer: Cofinity Advantage |
$139.04
|
| Rate for Payer: Cofinity Commercial |
$170.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.90
|
| Rate for Payer: Healthscope Commercial |
$178.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.97
|
| Rate for Payer: PHP Commercial |
$168.84
|
| Rate for Payer: Priority Health SBD |
$125.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC Core |
$4.42
|
| Rate for Payer: UHC Exchange |
$4.42
|
|
|
BORTEZOMIB 3.5 MG/3.5ML INJECTION SOL (WET VIAL)
|
Facility
|
OP
|
$198.63
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
4083583902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$178.77 |
| Rate for Payer: Aetna Commercial |
$168.84
|
| Rate for Payer: Aetna Medicare |
$99.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.11
|
| Rate for Payer: BCBS Complete |
$79.45
|
| Rate for Payer: BCBS Trust/PPO |
$6.57
|
| Rate for Payer: BCN Commercial |
$6.57
|
| Rate for Payer: Cash Price |
$158.90
|
| Rate for Payer: Cash Price |
$158.90
|
| Rate for Payer: Cofinity Advantage |
$139.04
|
| Rate for Payer: Cofinity Commercial |
$170.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.90
|
| Rate for Payer: Healthscope Commercial |
$178.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.97
|
| Rate for Payer: PHP Commercial |
$168.84
|
| Rate for Payer: Priority Health SBD |
$125.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC Core |
$4.42
|
| Rate for Payer: UHC Exchange |
$4.42
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$7,648.97
|
|
|
Service Code
|
APR-DRG 1323
|
| Min. Negotiated Rate |
$7,284.73 |
| Max. Negotiated Rate |
$7,648.97 |
| Rate for Payer: BCBS Complete |
$7,648.97
|
| Rate for Payer: Mclaren Medicaid |
$7,284.73
|
| Rate for Payer: Meridian Medicaid |
$7,648.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,284.73
|
| Rate for Payer: UHC Medicaid |
$7,284.73
|
| Rate for Payer: UHCCP Medicaid |
$7,284.73
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$4,569.77
|
|
|
Service Code
|
APR-DRG 1322
|
| Min. Negotiated Rate |
$4,352.17 |
| Max. Negotiated Rate |
$4,569.77 |
| Rate for Payer: BCBS Complete |
$4,569.77
|
| Rate for Payer: Mclaren Medicaid |
$4,352.17
|
| Rate for Payer: Meridian Medicaid |
$4,569.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,352.17
|
| Rate for Payer: UHC Medicaid |
$4,352.17
|
| Rate for Payer: UHCCP Medicaid |
$4,352.17
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$3,306.79
|
|
|
Service Code
|
APR-DRG 1321
|
| Min. Negotiated Rate |
$3,149.33 |
| Max. Negotiated Rate |
$3,306.79 |
| Rate for Payer: BCBS Complete |
$3,306.79
|
| Rate for Payer: Mclaren Medicaid |
$3,149.33
|
| Rate for Payer: Meridian Medicaid |
$3,306.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,149.33
|
| Rate for Payer: UHC Medicaid |
$3,149.33
|
| Rate for Payer: UHCCP Medicaid |
$3,149.33
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$9,525.38
|
|
|
Service Code
|
APR-DRG 1324
|
| Min. Negotiated Rate |
$9,071.79 |
| Max. Negotiated Rate |
$9,525.38 |
| Rate for Payer: BCBS Complete |
$9,525.38
|
| Rate for Payer: Mclaren Medicaid |
$9,071.79
|
| Rate for Payer: Meridian Medicaid |
$9,525.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,071.79
|
| Rate for Payer: UHC Medicaid |
$9,071.79
|
| Rate for Payer: UHCCP Medicaid |
$9,071.79
|
|
|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$59,821.48
|
|
|
Service Code
|
MSDRG 584
|
| Min. Negotiated Rate |
$16,266.67 |
| Max. Negotiated Rate |
$59,821.48 |
| Rate for Payer: Aetna Medicare |
$17,807.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,403.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,403.51
|
| Rate for Payer: BCBS MAPPO |
$17,122.81
|
| Rate for Payer: BCBS Trust/PPO |
$59,821.48
|
| Rate for Payer: BCN Commercial |
$59,821.48
|
| Rate for Payer: BCN Medicare Advantage |
$17,122.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,122.81
|
| Rate for Payer: Mclaren Medicare |
$17,122.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,978.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,691.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,835.09
|
| Rate for Payer: Nomi Health Commercial |
$27,615.03
|
| Rate for Payer: PACE Medicare |
$16,266.67
|
| Rate for Payer: PACE SWMI |
$17,122.81
|
| Rate for Payer: PHP Medicare Advantage |
$17,122.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34,512.67
|
| Rate for Payer: Priority Health Medicare |
$17,122.81
|
| Rate for Payer: Priority Health Tiered Network |
$27,610.13
|
| Rate for Payer: Railroad Medicare Medicare |
$17,122.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,893.41
|
| Rate for Payer: UHC Core |
$29,192.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,122.81
|
| Rate for Payer: UHC Exchange |
$23,840.98
|
| Rate for Payer: VA VA |
$17,122.81
|
|
|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$52,195.16
|
|
|
Service Code
|
MSDRG 585
|
| Min. Negotiated Rate |
$14,713.13 |
| Max. Negotiated Rate |
$52,195.16 |
| Rate for Payer: Aetna Medicare |
$16,107.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,359.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,359.39
|
| Rate for Payer: BCBS MAPPO |
$15,487.51
|
| Rate for Payer: BCBS Trust/PPO |
$52,195.16
|
| Rate for Payer: BCN Commercial |
$52,195.16
|
| Rate for Payer: BCN Medicare Advantage |
$15,487.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,487.51
|
| Rate for Payer: Mclaren Medicare |
$15,487.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,261.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,810.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,036.26
|
| Rate for Payer: Nomi Health Commercial |
$24,885.39
|
| Rate for Payer: PACE Medicare |
$14,713.13
|
| Rate for Payer: PACE SWMI |
$15,487.51
|
| Rate for Payer: PHP Medicare Advantage |
$15,487.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31,101.22
|
| Rate for Payer: Priority Health Medicare |
$15,487.51
|
| Rate for Payer: Priority Health Tiered Network |
$24,880.97
|
| Rate for Payer: Railroad Medicare Medicare |
$15,487.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,444.33
|
| Rate for Payer: UHC Core |
$26,307.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,487.51
|
| Rate for Payer: UHC Exchange |
$21,484.39
|
| Rate for Payer: VA VA |
$15,487.51
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$8,387.95
|
|
|
Service Code
|
APR-DRG 3631
|
| Min. Negotiated Rate |
$7,988.53 |
| Max. Negotiated Rate |
$8,387.95 |
| Rate for Payer: BCBS Complete |
$8,387.95
|
| Rate for Payer: Mclaren Medicaid |
$7,988.53
|
| Rate for Payer: Meridian Medicaid |
$8,387.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,988.53
|
| Rate for Payer: UHC Medicaid |
$7,988.53
|
| Rate for Payer: UHCCP Medicaid |
$7,988.53
|
|
