|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$1,152.85
|
|
|
Service Code
|
NDC 0006-0952-54
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$726.30 |
| Max. Negotiated Rate |
$1,037.56 |
| Rate for Payer: Aetna Commercial |
$979.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$749.35
|
| Rate for Payer: Cash Price |
$922.28
|
| Rate for Payer: Cofinity Commercial |
$807.00
|
| Rate for Payer: Cofinity Commercial |
$991.45
|
| Rate for Payer: Healthscope Commercial |
$1,037.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$979.92
|
| Rate for Payer: PHP Commercial |
$979.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.00
|
| Rate for Payer: Priority Health SBD |
$726.30
|
|
|
LOTEPREDNOL ETABONATE 0.5 % EYE GEL DROPS
|
Facility
|
IP
|
$830.80
|
|
|
Service Code
|
NDC 24208-503-07
|
| Hospital Charge Code |
163667
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$523.40 |
| Max. Negotiated Rate |
$747.72 |
| Rate for Payer: Aetna Commercial |
$706.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$540.02
|
| Rate for Payer: Cash Price |
$664.64
|
| Rate for Payer: Cofinity Commercial |
$581.56
|
| Rate for Payer: Cofinity Commercial |
$714.49
|
| Rate for Payer: Healthscope Commercial |
$747.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$706.18
|
| Rate for Payer: PHP Commercial |
$706.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.56
|
| Rate for Payer: Priority Health SBD |
$523.40
|
|
|
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC
|
Facility
|
IP
|
$42,997.92
|
|
|
Service Code
|
MS-DRG 493
|
| Min. Negotiated Rate |
$16,899.81 |
| Max. Negotiated Rate |
$42,997.92 |
| Rate for Payer: Aetna Medicare |
$18,500.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,236.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,236.59
|
| Rate for Payer: BCBS MAPPO |
$17,789.27
|
| Rate for Payer: BCBS Trust/PPO |
$42,997.92
|
| Rate for Payer: BCN Medicare Advantage |
$17,789.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,789.27
|
| Rate for Payer: Mclaren Medicare |
$17,789.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,678.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,457.66
|
| Rate for Payer: PACE Medicare |
$16,899.81
|
| Rate for Payer: PACE SWMI |
$17,789.27
|
| Rate for Payer: PHP Medicare Advantage |
$17,789.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,464.20
|
| Rate for Payer: Priority Health Medicare |
$17,789.27
|
| Rate for Payer: Priority Health Narrow Network |
$27,571.36
|
| Rate for Payer: Railroad Medicare Medicare |
$17,789.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36,635.53
|
| Rate for Payer: UHC Core |
$22,479.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,789.27
|
| Rate for Payer: UHC Exchange |
$24,077.04
|
| Rate for Payer: UHC Medicare Advantage |
$18,322.95
|
| Rate for Payer: VA VA |
$17,789.27
|
|
|
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC
|
Facility
|
IP
|
$53,481.14
|
|
|
Service Code
|
MS-DRG 492
|
| Min. Negotiated Rate |
$24,154.76 |
| Max. Negotiated Rate |
$53,481.14 |
| Rate for Payer: Aetna Medicare |
$26,443.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,782.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,782.58
|
| Rate for Payer: BCBS MAPPO |
$25,426.06
|
| Rate for Payer: BCBS Trust/PPO |
$53,481.14
|
| Rate for Payer: BCN Medicare Advantage |
$25,426.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,426.06
|
| Rate for Payer: Mclaren Medicare |
$25,426.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26,697.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,239.97
|
| Rate for Payer: PACE Medicare |
$24,154.76
|
| Rate for Payer: PACE SWMI |
$25,426.06
|
| Rate for Payer: PHP Medicare Advantage |
$25,426.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49,680.86
|
| Rate for Payer: Priority Health Medicare |
$25,426.06
|
| Rate for Payer: Priority Health Narrow Network |
$39,744.69
|
| Rate for Payer: Railroad Medicare Medicare |
$25,426.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52,810.87
|
| Rate for Payer: UHC Core |
$32,405.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$25,426.06
|
| Rate for Payer: UHC Exchange |
$34,707.55
|
| Rate for Payer: UHC Medicare Advantage |
$26,188.84
|
| Rate for Payer: VA VA |
$25,426.06
|
|
|
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC
|
Facility
|
IP
|
$30,727.23
|
|
|
Service Code
|
MS-DRG 494
|
| Min. Negotiated Rate |
$13,256.60 |
| Max. Negotiated Rate |
$30,727.23 |
| Rate for Payer: Aetna Medicare |
$14,512.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,442.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,442.90
|
| Rate for Payer: BCBS MAPPO |
$13,954.32
|
| Rate for Payer: BCBS Trust/PPO |
$30,727.23
|
| Rate for Payer: BCN Medicare Advantage |
$13,954.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,954.32
|
| Rate for Payer: Mclaren Medicare |
$13,954.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,652.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,047.47
|
| Rate for Payer: PACE Medicare |
$13,256.60
|
| Rate for Payer: PACE SWMI |
$13,954.32
|
| Rate for Payer: PHP Medicare Advantage |
$13,954.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,822.87
|
| Rate for Payer: Priority Health Medicare |
$13,954.32
|
| Rate for Payer: Priority Health Narrow Network |
$21,458.30
|
| Rate for Payer: Railroad Medicare Medicare |
$13,954.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,512.78
|
| Rate for Payer: UHC Core |
$17,495.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,954.32
|
| Rate for Payer: UHC Exchange |
$18,738.73
|
| Rate for Payer: UHC Medicare Advantage |
$14,372.95
|
| Rate for Payer: VA VA |
$13,954.32
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
IP
|
$1,668.11
|
|
|
Service Code
|
NDC 69339-162-17
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,050.91 |
| Max. Negotiated Rate |
$1,501.30 |
| Rate for Payer: Aetna Commercial |
$1,417.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.27
|
| Rate for Payer: Cash Price |
$1,334.49
|
| Rate for Payer: Cofinity Commercial |
$1,167.68
|
| Rate for Payer: Cofinity Commercial |
$1,434.57
|
| Rate for Payer: Healthscope Commercial |
$1,501.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,417.89
|
| Rate for Payer: PHP Commercial |
$1,417.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.68
|
| Rate for Payer: Priority Health SBD |
$1,050.91
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
IP
|
$41.71
|
|
|
Service Code
|
NDC 69339-162-98
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.28 |
| Max. Negotiated Rate |
$37.54 |
| Rate for Payer: Aetna Commercial |
$35.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.11
|
| Rate for Payer: Cash Price |
$33.37
|
| Rate for Payer: Cofinity Commercial |
$29.20
|
| Rate for Payer: Cofinity Commercial |
$35.87
|
| Rate for Payer: Healthscope Commercial |
$37.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.45
|
| Rate for Payer: PHP Commercial |
$35.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.20
|
| Rate for Payer: Priority Health SBD |
$26.28
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
IP
|
$1,276.95
|
|
|
Service Code
|
NDC 64764-080-60
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$804.48 |
| Max. Negotiated Rate |
$1,149.26 |
| Rate for Payer: Aetna Commercial |
$1,085.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.02
|
| Rate for Payer: Cash Price |
$1,021.56
|
| Rate for Payer: Cofinity Commercial |
$1,098.18
|
| Rate for Payer: Cofinity Commercial |
$893.86
|
| Rate for Payer: Healthscope Commercial |
$1,149.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,085.41
|
| Rate for Payer: PHP Commercial |
$1,085.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$893.86
|
| Rate for Payer: Priority Health SBD |
$804.48
|
|
|
LUMATEPERONE 42 MG CAPSULE
|
Facility
|
IP
|
$5,127.76
|
|
|
Service Code
|
NDC 72060-142-30
|
| Hospital Charge Code |
192596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,230.49 |
| Max. Negotiated Rate |
$4,614.98 |
| Rate for Payer: Aetna Commercial |
$4,358.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,333.04
|
| Rate for Payer: Cash Price |
$4,102.21
|
| Rate for Payer: Cofinity Commercial |
$3,589.43
|
| Rate for Payer: Cofinity Commercial |
$4,409.87
|
| Rate for Payer: Healthscope Commercial |
$4,614.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,358.60
|
| Rate for Payer: PHP Commercial |
$4,358.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,589.43
|
| Rate for Payer: Priority Health SBD |
$3,230.49
|
|
|
LUMATEPERONE 42 MG CAPSULE
|
Facility
|
IP
|
$170.93
|
|
|
Service Code
|
NDC 72060-142-01
|
| Hospital Charge Code |
192596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.69 |
| Max. Negotiated Rate |
$153.84 |
| Rate for Payer: Aetna Commercial |
$145.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.10
|
| Rate for Payer: Cash Price |
$136.74
|
| Rate for Payer: Cofinity Commercial |
$119.65
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Healthscope Commercial |
$153.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$145.29
|
| Rate for Payer: PHP Commercial |
$145.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.65
|
| Rate for Payer: Priority Health SBD |
$107.69
|
|
|
LUNG TRANSPLANT
|
Facility
|
IP
|
$198,513.75
|
|
|
Service Code
|
MS-DRG 007
|
| Min. Negotiated Rate |
$84,391.15 |
| Max. Negotiated Rate |
$198,513.75 |
| Rate for Payer: Aetna Medicare |
$92,386.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111,040.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111,040.99
|
| Rate for Payer: BCBS MAPPO |
$88,832.79
|
| Rate for Payer: BCBS Trust/PPO |
$198,513.75
|
| Rate for Payer: BCN Medicare Advantage |
$88,832.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88,832.79
|
| Rate for Payer: Mclaren Medicare |
$88,832.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$93,274.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102,157.71
|
| Rate for Payer: PACE Medicare |
$84,391.15
|
| Rate for Payer: PACE SWMI |
$88,832.79
|
| Rate for Payer: PHP Medicare Advantage |
$88,832.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176,021.86
|
| Rate for Payer: Priority Health Medicare |
$88,832.79
|
| Rate for Payer: Priority Health Narrow Network |
$140,817.49
|
| Rate for Payer: Railroad Medicare Medicare |
$88,832.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187,111.67
|
| Rate for Payer: UHC Core |
$114,813.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$88,832.79
|
| Rate for Payer: UHC Exchange |
$122,970.66
|
| Rate for Payer: UHC Medicare Advantage |
$91,497.77
|
| Rate for Payer: VA VA |
$88,832.79
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
IP
|
$12.43
|
|
|
Service Code
|
NDC 60687-747-11
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$11.19 |
| Rate for Payer: Aetna Commercial |
$10.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.08
|
| Rate for Payer: Cash Price |
$9.94
|
| Rate for Payer: Cofinity Commercial |
$10.69
|
| Rate for Payer: Cofinity Commercial |
$8.70
|
| Rate for Payer: Healthscope Commercial |
$11.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.57
|
| Rate for Payer: PHP Commercial |
$10.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.70
|
| Rate for Payer: Priority Health SBD |
$7.83
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
IP
|
$372.74
|
|
|
Service Code
|
NDC 60687-747-21
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.83 |
| Max. Negotiated Rate |
$335.47 |
| Rate for Payer: Aetna Commercial |
$316.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.28
|
| Rate for Payer: Cash Price |
$298.19
|
| Rate for Payer: Cofinity Commercial |
$260.92
|
| Rate for Payer: Cofinity Commercial |
$320.56
|
| Rate for Payer: Healthscope Commercial |
$335.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.83
|
| Rate for Payer: PHP Commercial |
$316.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.92
|
| Rate for Payer: Priority Health SBD |
$234.83
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
IP
|
$101.52
|
|
|
Service Code
|
NDC 67877-638-30
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.96 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Commercial |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.29
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.06
|
| Rate for Payer: Priority Health SBD |
$63.96
|
|
|
LURASIDONE 40 MG TABLET
|
Facility
|
IP
|
$4,735.26
|
|
|
Service Code
|
NDC 63402-304-30
|
| Hospital Charge Code |
107668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,983.21 |
| Max. Negotiated Rate |
$4,261.73 |
| Rate for Payer: Aetna Commercial |
$4,024.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,077.92
|
| Rate for Payer: Cash Price |
$3,788.21
|
| Rate for Payer: Cofinity Commercial |
$3,314.68
|
| Rate for Payer: Cofinity Commercial |
$4,072.32
|
| Rate for Payer: Healthscope Commercial |
$4,261.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,024.97
|
| Rate for Payer: PHP Commercial |
$4,024.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,314.68
|
| Rate for Payer: Priority Health SBD |
$2,983.21
|
|
|
LURASIDONE 80 MG TABLET
|
Facility
|
IP
|
$4,735.26
|
|
|
Service Code
|
NDC 63402-308-30
|
| Hospital Charge Code |
107669
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,983.21 |
| Max. Negotiated Rate |
$4,261.73 |
| Rate for Payer: Aetna Commercial |
$4,024.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,077.92
|
| Rate for Payer: Cash Price |
$3,788.21
|
| Rate for Payer: Cofinity Commercial |
$3,314.68
|
| Rate for Payer: Cofinity Commercial |
$4,072.32
|
| Rate for Payer: Healthscope Commercial |
$4,261.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,024.97
|
| Rate for Payer: PHP Commercial |
$4,024.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,314.68
|
| Rate for Payer: Priority Health SBD |
$2,983.21
|
|
|
LURBINECTEDIN 4 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20,358.00
|
|
|
Service Code
|
HCPCS J9223
|
| Hospital Charge Code |
194141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.40 |
| Max. Negotiated Rate |
$18,322.20 |
| Rate for Payer: Aetna Commercial |
$17,304.30
|
| Rate for Payer: Aetna Medicare |
$208.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,232.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$250.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$250.01
|
| Rate for Payer: BCBS Complete |
$114.89
|
| Rate for Payer: BCBS MAPPO |
$200.01
|
| Rate for Payer: BCBS Trust/PPO |
$592.12
|
| Rate for Payer: BCN Medicare Advantage |
$200.01
|
| Rate for Payer: Cash Price |
$16,286.40
|
| Rate for Payer: Cash Price |
$16,286.40
|
| Rate for Payer: Cofinity Commercial |
$17,507.88
|
| Rate for Payer: Cofinity Commercial |
$14,250.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.01
|
| Rate for Payer: Healthscope Commercial |
$18,322.20
|
| Rate for Payer: Mclaren Medicaid |
$109.40
|
| Rate for Payer: Mclaren Medicare |
$200.01
|
| Rate for Payer: Meridian Medicaid |
$114.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$210.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$230.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17,304.30
|
| Rate for Payer: PACE Medicare |
$190.01
|
| Rate for Payer: PACE SWMI |
$200.01
|
| Rate for Payer: PHP Commercial |
$17,304.30
|
| Rate for Payer: PHP Medicare Advantage |
$200.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,250.60
|
| Rate for Payer: Priority Health Medicare |
$200.01
|
| Rate for Payer: Priority Health SBD |
$12,825.54
|
| Rate for Payer: Railroad Medicare Medicare |
$200.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$200.01
|
| Rate for Payer: UHC Medicare Advantage |
$206.01
|
| Rate for Payer: VA VA |
$200.01
|
|
|
LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$10,077.34
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.86 |
| Max. Negotiated Rate |
$9,069.61 |
| Rate for Payer: Aetna Commercial |
$8,565.74
|
| Rate for Payer: Aetna Medicare |
$41.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,550.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.96
|
| Rate for Payer: BCBS Complete |
$22.96
|
| Rate for Payer: BCBS MAPPO |
$39.97
|
| Rate for Payer: BCBS Trust/PPO |
$118.32
|
| Rate for Payer: BCN Medicare Advantage |
$39.97
|
| Rate for Payer: Cash Price |
$8,061.87
|
| Rate for Payer: Cash Price |
$8,061.87
|
| Rate for Payer: Cofinity Commercial |
$8,666.51
|
| Rate for Payer: Cofinity Commercial |
$7,054.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.97
|
| Rate for Payer: Healthscope Commercial |
$9,069.61
|
| Rate for Payer: Mclaren Medicaid |
$21.86
|
| Rate for Payer: Mclaren Medicare |
$39.97
|
| Rate for Payer: Meridian Medicaid |
$22.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,565.74
|
| Rate for Payer: PACE Medicare |
$37.97
|
| Rate for Payer: PACE SWMI |
$39.97
|
| Rate for Payer: PHP Commercial |
$8,565.74
|
| Rate for Payer: PHP Medicare Advantage |
$39.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,054.14
|
| Rate for Payer: Priority Health Medicare |
$39.97
|
| Rate for Payer: Priority Health SBD |
$6,348.72
|
| Rate for Payer: Railroad Medicare Medicare |
$39.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.97
|
| Rate for Payer: UHC Medicare Advantage |
$41.17
|
| Rate for Payer: VA VA |
$39.97
|
|
|
LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$10,077.34
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,348.72 |
| Max. Negotiated Rate |
$9,069.61 |
| Rate for Payer: Aetna Commercial |
$8,565.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,550.27
|
| Rate for Payer: Cash Price |
$8,061.87
|
| Rate for Payer: Cofinity Commercial |
$8,666.51
|
| Rate for Payer: Cofinity Commercial |
$7,054.14
|
| Rate for Payer: Healthscope Commercial |
$9,069.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,565.74
|
| Rate for Payer: PHP Commercial |
$8,565.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,054.14
|
| Rate for Payer: Priority Health SBD |
$6,348.72
|
|
|
LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$30,231.95
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.86 |
| Max. Negotiated Rate |
$27,208.76 |
| Rate for Payer: Aetna Commercial |
$25,697.16
|
| Rate for Payer: Aetna Medicare |
$41.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,650.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.96
|
| Rate for Payer: BCBS Complete |
$22.96
|
| Rate for Payer: BCBS MAPPO |
$39.97
|
| Rate for Payer: BCBS Trust/PPO |
$118.32
|
| Rate for Payer: BCN Medicare Advantage |
$39.97
|
| Rate for Payer: Cash Price |
$24,185.56
|
| Rate for Payer: Cash Price |
$24,185.56
|
| Rate for Payer: Cofinity Commercial |
$21,162.36
|
| Rate for Payer: Cofinity Commercial |
$25,999.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.97
|
| Rate for Payer: Healthscope Commercial |
$27,208.76
|
| Rate for Payer: Mclaren Medicaid |
$21.86
|
| Rate for Payer: Mclaren Medicare |
$39.97
|
| Rate for Payer: Meridian Medicaid |
$22.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25,697.16
|
| Rate for Payer: PACE Medicare |
$37.97
|
| Rate for Payer: PACE SWMI |
$39.97
|
| Rate for Payer: PHP Commercial |
$25,697.16
|
| Rate for Payer: PHP Medicare Advantage |
$39.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21,162.36
|
| Rate for Payer: Priority Health Medicare |
$39.97
|
| Rate for Payer: Priority Health SBD |
$19,046.13
|
| Rate for Payer: Railroad Medicare Medicare |
$39.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.97
|
| Rate for Payer: UHC Medicare Advantage |
$41.17
|
| Rate for Payer: VA VA |
$39.97
|
|
|
LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$30,231.95
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19,046.13 |
| Max. Negotiated Rate |
$27,208.76 |
| Rate for Payer: Aetna Commercial |
$25,697.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,650.77
|
| Rate for Payer: Cash Price |
$24,185.56
|
| Rate for Payer: Cofinity Commercial |
$21,162.36
|
| Rate for Payer: Cofinity Commercial |
$25,999.48
|
| Rate for Payer: Healthscope Commercial |
$27,208.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25,697.16
|
| Rate for Payer: PHP Commercial |
$25,697.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21,162.36
|
| Rate for Payer: Priority Health SBD |
$19,046.13
|
|
|
LYMPHOCYTE,ANTI-THYMO IMMUNE GLOBULIN 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,213.70
|
|
|
Service Code
|
HCPCS J7504
|
| Hospital Charge Code |
10475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,964.53 |
| Max. Negotiated Rate |
$10,632.60 |
| Rate for Payer: Aetna Commercial |
$7,831.64
|
| Rate for Payer: Aetna Medicare |
$3,735.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,988.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,489.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,489.32
|
| Rate for Payer: BCBS Complete |
$2,062.93
|
| Rate for Payer: BCBS MAPPO |
$3,591.46
|
| Rate for Payer: BCBS Trust/PPO |
$10,632.60
|
| Rate for Payer: BCN Medicare Advantage |
$3,591.46
|
| Rate for Payer: Cash Price |
$7,370.96
|
| Rate for Payer: Cash Price |
$7,370.96
|
| Rate for Payer: Cofinity Commercial |
$7,923.78
|
| Rate for Payer: Cofinity Commercial |
$6,449.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,591.46
|
| Rate for Payer: Healthscope Commercial |
$8,292.33
|
| Rate for Payer: Mclaren Medicaid |
$1,964.53
|
| Rate for Payer: Mclaren Medicare |
$3,591.46
|
| Rate for Payer: Meridian Medicaid |
$2,062.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,771.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,130.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,831.64
|
| Rate for Payer: PACE Medicare |
$3,411.89
|
| Rate for Payer: PACE SWMI |
$3,591.46
|
| Rate for Payer: PHP Commercial |
$7,831.64
|
| Rate for Payer: PHP Medicare Advantage |
$3,591.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,964.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,449.59
|
| Rate for Payer: Priority Health Medicare |
$3,591.46
|
| Rate for Payer: Priority Health SBD |
$5,804.63
|
| Rate for Payer: Railroad Medicare Medicare |
$3,591.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,591.46
|
| Rate for Payer: UHC Medicare Advantage |
$3,699.20
|
| Rate for Payer: VA VA |
$3,591.46
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$43,002.31
|
|
|
Service Code
|
MS-DRG 821
|
| Min. Negotiated Rate |
$15,739.45 |
| Max. Negotiated Rate |
$43,002.31 |
| Rate for Payer: Aetna Medicare |
$17,230.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,709.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,709.80
|
| Rate for Payer: BCBS MAPPO |
$16,567.84
|
| Rate for Payer: BCBS Trust/PPO |
$43,002.31
|
| Rate for Payer: BCN Medicare Advantage |
$16,567.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,567.84
|
| Rate for Payer: Mclaren Medicare |
$16,567.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,396.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,053.02
|
| Rate for Payer: PACE Medicare |
$15,739.45
|
| Rate for Payer: PACE SWMI |
$16,567.84
|
| Rate for Payer: PHP Medicare Advantage |
$16,567.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,030.46
|
| Rate for Payer: Priority Health Medicare |
$16,567.84
|
| Rate for Payer: Priority Health Narrow Network |
$25,624.37
|
| Rate for Payer: Railroad Medicare Medicare |
$16,567.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,048.45
|
| Rate for Payer: UHC Core |
$20,892.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,567.84
|
| Rate for Payer: UHC Exchange |
$22,376.80
|
| Rate for Payer: UHC Medicare Advantage |
$17,064.88
|
| Rate for Payer: VA VA |
$16,567.84
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$98,771.58
|
|
|
Service Code
|
MS-DRG 820
|
| Min. Negotiated Rate |
$41,837.81 |
| Max. Negotiated Rate |
$98,771.58 |
| Rate for Payer: Aetna Medicare |
$45,801.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55,049.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55,049.75
|
| Rate for Payer: BCBS MAPPO |
$44,039.80
|
| Rate for Payer: BCBS Trust/PPO |
$98,771.58
|
| Rate for Payer: BCN Medicare Advantage |
$44,039.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44,039.80
|
| Rate for Payer: Mclaren Medicare |
$44,039.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46,241.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50,645.77
|
| Rate for Payer: PACE Medicare |
$41,837.81
|
| Rate for Payer: PACE SWMI |
$44,039.80
|
| Rate for Payer: PHP Medicare Advantage |
$44,039.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86,769.66
|
| Rate for Payer: Priority Health Medicare |
$44,039.80
|
| Rate for Payer: Priority Health Narrow Network |
$69,415.73
|
| Rate for Payer: Railroad Medicare Medicare |
$44,039.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92,236.36
|
| Rate for Payer: UHC Core |
$56,597.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$44,039.80
|
| Rate for Payer: UHC Exchange |
$60,618.17
|
| Rate for Payer: UHC Medicare Advantage |
$45,360.99
|
| Rate for Payer: VA VA |
$44,039.80
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$29,789.58
|
|
|
Service Code
|
MS-DRG 822
|
| Min. Negotiated Rate |
$8,943.59 |
| Max. Negotiated Rate |
$29,789.58 |
| Rate for Payer: Aetna Medicare |
$9,790.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,767.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,767.89
|
| Rate for Payer: BCBS MAPPO |
$9,414.31
|
| Rate for Payer: BCBS Trust/PPO |
$29,789.58
|
| Rate for Payer: BCN Medicare Advantage |
$9,414.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,414.31
|
| Rate for Payer: Mclaren Medicare |
$9,414.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,885.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,826.46
|
| Rate for Payer: PACE Medicare |
$8,943.59
|
| Rate for Payer: PACE SWMI |
$9,414.31
|
| Rate for Payer: PHP Medicare Advantage |
$9,414.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,776.68
|
| Rate for Payer: Priority Health Medicare |
$9,414.31
|
| Rate for Payer: Priority Health Narrow Network |
$14,221.34
|
| Rate for Payer: Railroad Medicare Medicare |
$9,414.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,896.66
|
| Rate for Payer: UHC Core |
$11,595.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,414.31
|
| Rate for Payer: UHC Exchange |
$12,418.97
|
| Rate for Payer: UHC Medicare Advantage |
$9,696.74
|
| Rate for Payer: VA VA |
$9,414.31
|
|
