|
DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$964.99
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76965
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$607.94 |
| Max. Negotiated Rate |
$868.49 |
| Rate for Payer: Aetna Commercial |
$820.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.24
|
| Rate for Payer: Cash Price |
$771.99
|
| Rate for Payer: Cofinity Commercial |
$675.49
|
| Rate for Payer: Cofinity Commercial |
$829.89
|
| Rate for Payer: Healthscope Commercial |
$868.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$820.24
|
| Rate for Payer: PHP Commercial |
$820.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.49
|
| Rate for Payer: Priority Health SBD |
$607.94
|
|
|
DARBEPOETIN ALFA 40 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
OP
|
$964.99
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$868.49 |
| Rate for Payer: Aetna Commercial |
$820.24
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$8.66
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$771.99
|
| Rate for Payer: Cash Price |
$771.99
|
| Rate for Payer: Cofinity Commercial |
$675.49
|
| Rate for Payer: Cofinity Commercial |
$829.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$868.49
|
| Rate for Payer: Mclaren Medicaid |
$1.60
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Medicaid |
$1.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$820.24
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$820.24
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.49
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health SBD |
$607.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: VA VA |
$2.93
|
|
|
DARBEPOETIN ALFA 500 MCG/ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$9,800.65
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,174.41 |
| Max. Negotiated Rate |
$8,820.58 |
| Rate for Payer: Aetna Commercial |
$8,330.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,370.42
|
| Rate for Payer: Cash Price |
$7,840.52
|
| Rate for Payer: Cofinity Commercial |
$6,860.46
|
| Rate for Payer: Cofinity Commercial |
$8,428.56
|
| Rate for Payer: Healthscope Commercial |
$8,820.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,330.55
|
| Rate for Payer: PHP Commercial |
$8,330.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,860.46
|
| Rate for Payer: Priority Health SBD |
$6,174.41
|
|
|
DARBEPOETIN ALFA 500 MCG/ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$9,800.65
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$8,820.58 |
| Rate for Payer: Aetna Commercial |
$8,330.55
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,370.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$8.66
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$7,840.52
|
| Rate for Payer: Cash Price |
$7,840.52
|
| Rate for Payer: Cofinity Commercial |
$6,860.46
|
| Rate for Payer: Cofinity Commercial |
$8,428.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$8,820.58
|
| Rate for Payer: Mclaren Medicaid |
$1.60
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Medicaid |
$1.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,330.55
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$8,330.55
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,860.46
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health SBD |
$6,174.41
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: VA VA |
$2.93
|
|
|
DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$1,447.49
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$911.92 |
| Max. Negotiated Rate |
$1,302.74 |
| Rate for Payer: Aetna Commercial |
$1,230.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.87
|
| Rate for Payer: Cash Price |
$1,157.99
|
| Rate for Payer: Cofinity Commercial |
$1,244.84
|
| Rate for Payer: Cofinity Commercial |
$1,013.24
|
| Rate for Payer: Healthscope Commercial |
$1,302.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,230.37
|
| Rate for Payer: PHP Commercial |
$1,230.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,013.24
|
| Rate for Payer: Priority Health SBD |
$911.92
|
|
|
DARUNAVIR 800 MG-COBICISTAT 150 MG TABLET
|
Facility
|
IP
|
$8,639.47
|
|
|
Service Code
|
NDC 59676-575-30
|
| Hospital Charge Code |
173955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5,442.87 |
| Max. Negotiated Rate |
$7,775.52 |
| Rate for Payer: Aetna Commercial |
$7,343.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,615.66
|
| Rate for Payer: Cash Price |
$6,911.58
|
| Rate for Payer: Cofinity Commercial |
$6,047.63
|
| Rate for Payer: Cofinity Commercial |
$7,429.94
|
| Rate for Payer: Healthscope Commercial |
$7,775.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,343.55
|
| Rate for Payer: PHP Commercial |
$7,343.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,047.63
|
| Rate for Payer: Priority Health SBD |
$5,442.87
|
|
|
DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,153.96
|
|
|
Service Code
|
HCPCS J9150
|
| Hospital Charge Code |
22661
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$726.99 |
| Max. Negotiated Rate |
$1,038.56 |
| Rate for Payer: Aetna Commercial |
$980.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.07
|
| Rate for Payer: Cash Price |
$923.17
|
| Rate for Payer: Cofinity Commercial |
$807.77
|
| Rate for Payer: Cofinity Commercial |
$992.41
|
| Rate for Payer: Healthscope Commercial |
$1,038.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$980.87
|
| Rate for Payer: PHP Commercial |
$980.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.77
|
| Rate for Payer: Priority Health SBD |
$726.99
|
|
|
DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,153.96
|
|
|
Service Code
|
HCPCS J9150
|
| Hospital Charge Code |
22661
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$1,038.56 |
| Rate for Payer: Aetna Commercial |
$980.87
|
| Rate for Payer: Aetna Medicare |
$37.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.59
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS MAPPO |
$35.67
|
| Rate for Payer: BCBS Trust/PPO |
$105.59
|
| Rate for Payer: BCN Medicare Advantage |
$35.67
|
| Rate for Payer: Cash Price |
$923.17
|
| Rate for Payer: Cash Price |
$923.17
|
| Rate for Payer: Cofinity Commercial |
$992.41
|
| Rate for Payer: Cofinity Commercial |
$807.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.67
|
| Rate for Payer: Healthscope Commercial |
$1,038.56
|
| Rate for Payer: Mclaren Medicaid |
$19.51
|
| Rate for Payer: Mclaren Medicare |
$35.67
|
| Rate for Payer: Meridian Medicaid |
$20.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$980.87
|
| Rate for Payer: PACE Medicare |
$33.89
|
| Rate for Payer: PACE SWMI |
$35.67
|
| Rate for Payer: PHP Commercial |
$980.87
|
| Rate for Payer: PHP Medicare Advantage |
$35.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.77
|
| Rate for Payer: Priority Health Medicare |
$35.67
|
| Rate for Payer: Priority Health SBD |
$726.99
|
| Rate for Payer: Railroad Medicare Medicare |
$35.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.67
|
| Rate for Payer: UHC Medicare Advantage |
$36.74
|
| Rate for Payer: VA VA |
$35.67
|
|
|
D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC
|
Facility
|
IP
|
$28,714.13
|
|
|
Service Code
|
MS-DRG 744
|
| Min. Negotiated Rate |
$13,346.91 |
| Max. Negotiated Rate |
$28,714.13 |
| Rate for Payer: Aetna Medicare |
$14,611.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,561.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,561.72
|
| Rate for Payer: BCBS MAPPO |
$14,049.38
|
| Rate for Payer: BCBS Trust/PPO |
$28,278.80
|
| Rate for Payer: BCN Medicare Advantage |
$14,049.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,049.38
|
| Rate for Payer: Mclaren Medicare |
$14,049.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,751.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,156.79
|
| Rate for Payer: PACE Medicare |
$13,346.91
|
| Rate for Payer: PACE SWMI |
$14,049.38
|
| Rate for Payer: PHP Medicare Advantage |
$14,049.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,012.29
|
| Rate for Payer: Priority Health Medicare |
$14,049.38
|
| Rate for Payer: Priority Health Narrow Network |
$21,609.83
|
| Rate for Payer: Railroad Medicare Medicare |
$14,049.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,714.13
|
| Rate for Payer: UHC Core |
$17,619.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,049.38
|
| Rate for Payer: UHC Exchange |
$18,871.06
|
| Rate for Payer: UHC Medicare Advantage |
$14,470.86
|
| Rate for Payer: VA VA |
$14,049.38
|
|
|
D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC
|
Facility
|
IP
|
$22,569.46
|
|
|
Service Code
|
MS-DRG 745
|
| Min. Negotiated Rate |
$7,555.42 |
| Max. Negotiated Rate |
$22,569.46 |
| Rate for Payer: Aetna Medicare |
$8,271.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,941.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,941.34
|
| Rate for Payer: BCBS MAPPO |
$7,953.07
|
| Rate for Payer: BCBS Trust/PPO |
$22,569.46
|
| Rate for Payer: BCN Medicare Advantage |
$7,953.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,953.07
|
| Rate for Payer: Mclaren Medicare |
$7,953.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,350.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,146.03
|
| Rate for Payer: PACE Medicare |
$7,555.42
|
| Rate for Payer: PACE SWMI |
$7,953.07
|
| Rate for Payer: PHP Medicare Advantage |
$7,953.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,865.08
|
| Rate for Payer: Priority Health Medicare |
$7,953.07
|
| Rate for Payer: Priority Health Narrow Network |
$11,892.06
|
| Rate for Payer: Railroad Medicare Medicare |
$7,953.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,801.62
|
| Rate for Payer: UHC Core |
$9,696.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,953.07
|
| Rate for Payer: UHC Exchange |
$10,384.90
|
| Rate for Payer: UHC Medicare Advantage |
$8,191.66
|
| Rate for Payer: VA VA |
$7,953.07
|
|
|
DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 11047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: BCBS Trust/PPO |
$249.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.73
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$94.30
|
|
|
DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$4,536.73
|
|
|
Service Code
|
CPT 11044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$220.04 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna Medicare |
$1,500.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,803.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,803.26
|
| Rate for Payer: BCBS Complete |
$828.64
|
| Rate for Payer: BCBS MAPPO |
$1,442.61
|
| Rate for Payer: BCBS Trust/PPO |
$807.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,442.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,442.61
|
| Rate for Payer: Mclaren Medicaid |
$789.11
|
| Rate for Payer: Mclaren Medicare |
$1,442.61
|
| Rate for Payer: Meridian Medicaid |
$828.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,514.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,659.00
|
| Rate for Payer: PACE Medicare |
$1,370.48
|
| Rate for Payer: PACE SWMI |
$1,442.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,442.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,442.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,442.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.04
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,442.61
|
| Rate for Payer: UHC Exchange |
$220.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,485.89
|
| Rate for Payer: VA VA |
$1,442.61
|
|
|
DEBRIDEMENT (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), OPEN WOUND, (EG, FIBRIN, DEVITALIZED EPIDERMIS AND/OR DERMIS, EXUDATE, DEBRIS, BIOFILM), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, USE OF A WHIRLPOOL, WHEN PERFORMED AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION, TOTAL WOUND(S) SURFACE AREA; FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 97597
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$34.38 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$92.48
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.82
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$34.38
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN, SUBCUTANEOUS TISSUE, MUSCLE FASCIA, AND MUSCLE
|
Facility
|
OP
|
$1,937.58
|
|
|
Service Code
|
CPT 11011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$252.88 |
| Max. Negotiated Rate |
$1,937.58 |
| Rate for Payer: Aetna Medicare |
$651.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$782.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$782.55
|
| Rate for Payer: BCBS Complete |
$359.60
|
| Rate for Payer: BCBS MAPPO |
$626.04
|
| Rate for Payer: BCBS Trust/PPO |
$252.88
|
| Rate for Payer: BCN Medicare Advantage |
$626.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.04
|
| Rate for Payer: Mclaren Medicaid |
$342.44
|
| Rate for Payer: Mclaren Medicare |
$626.04
|
| Rate for Payer: Meridian Medicaid |
$359.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$657.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.95
|
| Rate for Payer: PACE Medicare |
$594.74
|
| Rate for Payer: PACE SWMI |
$626.04
|
| Rate for Payer: PHP Medicare Advantage |
$626.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,937.58
|
| Rate for Payer: Priority Health Medicare |
$626.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,550.06
|
| Rate for Payer: Railroad Medicare Medicare |
$626.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.85
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$626.04
|
| Rate for Payer: UHC Exchange |
$290.77
|
| Rate for Payer: UHC Medicare Advantage |
$644.82
|
| Rate for Payer: VA VA |
$626.04
|
|
|
DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 11046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$53.37 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: BCBS Trust/PPO |
$147.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.71
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$53.37
|
|
|
DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,757.43
|
|
|
Service Code
|
CPT 11043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$149.97 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna Medicare |
$581.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.54
|
| Rate for Payer: BCBS Complete |
$320.99
|
| Rate for Payer: BCBS MAPPO |
$558.83
|
| Rate for Payer: BCBS Trust/PPO |
$417.77
|
| Rate for Payer: BCN Medicare Advantage |
$558.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.83
|
| Rate for Payer: Mclaren Medicaid |
$305.68
|
| Rate for Payer: Mclaren Medicare |
$558.83
|
| Rate for Payer: Meridian Medicaid |
$320.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.65
|
| Rate for Payer: PACE Medicare |
$530.89
|
| Rate for Payer: PACE SWMI |
$558.83
|
| Rate for Payer: PHP Medicare Advantage |
$558.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Railroad Medicare Medicare |
$558.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.97
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.83
|
| Rate for Payer: UHC Exchange |
$149.97
|
| Rate for Payer: UHC Medicare Advantage |
$575.59
|
| Rate for Payer: VA VA |
$558.83
|
|
|
DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE
|
Facility
|
OP
|
$1,757.43
|
|
|
Service Code
|
CPT 11000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$23.55 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna Medicare |
$581.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.54
|
| Rate for Payer: BCBS Complete |
$320.99
|
| Rate for Payer: BCBS MAPPO |
$558.83
|
| Rate for Payer: BCBS Trust/PPO |
$23.55
|
| Rate for Payer: BCN Medicare Advantage |
$558.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.83
|
| Rate for Payer: Mclaren Medicaid |
$305.68
|
| Rate for Payer: Mclaren Medicare |
$558.83
|
| Rate for Payer: Meridian Medicaid |
$320.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.65
|
| Rate for Payer: PACE Medicare |
$530.89
|
| Rate for Payer: PACE SWMI |
$558.83
|
| Rate for Payer: PHP Medicare Advantage |
$558.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Railroad Medicare Medicare |
$558.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.54
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.83
|
| Rate for Payer: UHC Exchange |
$26.85
|
| Rate for Payer: UHC Medicare Advantage |
$575.59
|
| Rate for Payer: VA VA |
$558.83
|
|
|
DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 11045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: BCBS Trust/PPO |
$81.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.02
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$24.56
|
|
|
DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,076.20
|
|
|
Service Code
|
CPT 11042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$59.27 |
| Max. Negotiated Rate |
$1,076.20 |
| Rate for Payer: Aetna Medicare |
$368.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.50
|
| Rate for Payer: BCBS Complete |
$203.80
|
| Rate for Payer: BCBS MAPPO |
$354.80
|
| Rate for Payer: BCBS Trust/PPO |
$179.10
|
| Rate for Payer: BCN Medicare Advantage |
$354.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.80
|
| Rate for Payer: Mclaren Medicaid |
$194.08
|
| Rate for Payer: Mclaren Medicare |
$354.80
|
| Rate for Payer: Meridian Medicaid |
$203.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.02
|
| Rate for Payer: PACE Medicare |
$337.06
|
| Rate for Payer: PACE SWMI |
$354.80
|
| Rate for Payer: PHP Medicare Advantage |
$354.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,076.20
|
| Rate for Payer: Priority Health Medicare |
$354.80
|
| Rate for Payer: Priority Health Narrow Network |
$860.96
|
| Rate for Payer: Railroad Medicare Medicare |
$354.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.20
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.80
|
| Rate for Payer: UHC Exchange |
$59.27
|
| Rate for Payer: UHC Medicare Advantage |
$365.44
|
| Rate for Payer: VA VA |
$354.80
|
|
|
DECITABINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,640.71
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
76364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5,976.64 |
| Rate for Payer: Aetna Commercial |
$5,644.60
|
| Rate for Payer: Aetna Commercial |
$6,685.14
|
| Rate for Payer: Aetna Commercial |
$410.98
|
| Rate for Payer: Aetna Commercial |
$6,037.10
|
| Rate for Payer: Aetna Commercial |
$595.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,112.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,316.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,616.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.28
|
| Rate for Payer: BCBS Complete |
$193.40
|
| Rate for Payer: BCBS Complete |
$3,145.95
|
| Rate for Payer: BCBS Complete |
$2,840.99
|
| Rate for Payer: BCBS Complete |
$2,656.28
|
| Rate for Payer: BCBS Complete |
$280.28
|
| Rate for Payer: BCBS Trust/PPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$5.00
|
| Rate for Payer: Cash Price |
$5,312.57
|
| Rate for Payer: Cash Price |
$386.80
|
| Rate for Payer: Cash Price |
$386.80
|
| Rate for Payer: Cash Price |
$5,312.57
|
| Rate for Payer: Cash Price |
$560.55
|
| Rate for Payer: Cash Price |
$560.55
|
| Rate for Payer: Cash Price |
$5,681.98
|
| Rate for Payer: Cash Price |
$5,681.98
|
| Rate for Payer: Cash Price |
$6,291.90
|
| Rate for Payer: Cash Price |
$6,291.90
|
| Rate for Payer: Cofinity Commercial |
$4,971.73
|
| Rate for Payer: Cofinity Commercial |
$6,108.12
|
| Rate for Payer: Cofinity Commercial |
$490.48
|
| Rate for Payer: Cofinity Commercial |
$602.59
|
| Rate for Payer: Cofinity Commercial |
$6,763.79
|
| Rate for Payer: Cofinity Commercial |
$5,505.41
|
| Rate for Payer: Cofinity Commercial |
$4,648.50
|
| Rate for Payer: Cofinity Commercial |
$338.45
|
| Rate for Payer: Cofinity Commercial |
$415.81
|
| Rate for Payer: Cofinity Commercial |
$5,711.01
|
| Rate for Payer: Healthscope Commercial |
$630.62
|
| Rate for Payer: Healthscope Commercial |
$6,392.22
|
| Rate for Payer: Healthscope Commercial |
$7,078.38
|
| Rate for Payer: Healthscope Commercial |
$5,976.64
|
| Rate for Payer: Healthscope Commercial |
$435.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,644.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,037.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$410.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,685.14
|
| Rate for Payer: PHP Commercial |
$6,037.10
|
| Rate for Payer: PHP Commercial |
$595.59
|
| Rate for Payer: PHP Commercial |
$5,644.60
|
| Rate for Payer: PHP Commercial |
$6,685.14
|
| Rate for Payer: PHP Commercial |
$410.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,505.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,648.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,971.73
|
| Rate for Payer: Priority Health SBD |
$304.60
|
| Rate for Payer: Priority Health SBD |
$441.43
|
| Rate for Payer: Priority Health SBD |
$4,183.65
|
| Rate for Payer: Priority Health SBD |
$4,474.56
|
| Rate for Payer: Priority Health SBD |
$4,954.87
|
|
|
DECITABINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$700.69
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
76364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$441.43 |
| Max. Negotiated Rate |
$630.62 |
| Rate for Payer: Aetna Commercial |
$595.59
|
| Rate for Payer: Aetna Commercial |
$410.98
|
| Rate for Payer: Aetna Commercial |
$637.97
|
| Rate for Payer: Aetna Commercial |
$471.12
|
| Rate for Payer: Aetna Commercial |
$844.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$487.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.05
|
| Rate for Payer: Cash Price |
$560.55
|
| Rate for Payer: Cash Price |
$600.44
|
| Rate for Payer: Cash Price |
$795.14
|
| Rate for Payer: Cash Price |
$443.41
|
| Rate for Payer: Cash Price |
$386.80
|
| Rate for Payer: Cofinity Commercial |
$854.77
|
| Rate for Payer: Cofinity Commercial |
$338.45
|
| Rate for Payer: Cofinity Commercial |
$415.81
|
| Rate for Payer: Cofinity Commercial |
$387.98
|
| Rate for Payer: Cofinity Commercial |
$476.66
|
| Rate for Payer: Cofinity Commercial |
$490.48
|
| Rate for Payer: Cofinity Commercial |
$602.59
|
| Rate for Payer: Cofinity Commercial |
$525.38
|
| Rate for Payer: Cofinity Commercial |
$645.47
|
| Rate for Payer: Cofinity Commercial |
$695.74
|
| Rate for Payer: Healthscope Commercial |
$630.62
|
| Rate for Payer: Healthscope Commercial |
$498.83
|
| Rate for Payer: Healthscope Commercial |
$894.53
|
| Rate for Payer: Healthscope Commercial |
$675.50
|
| Rate for Payer: Healthscope Commercial |
$435.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$637.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$410.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$844.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$471.12
|
| Rate for Payer: PHP Commercial |
$471.12
|
| Rate for Payer: PHP Commercial |
$410.98
|
| Rate for Payer: PHP Commercial |
$637.97
|
| Rate for Payer: PHP Commercial |
$844.83
|
| Rate for Payer: PHP Commercial |
$595.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.48
|
| Rate for Payer: Priority Health SBD |
$472.85
|
| Rate for Payer: Priority Health SBD |
$304.60
|
| Rate for Payer: Priority Health SBD |
$349.18
|
| Rate for Payer: Priority Health SBD |
$441.43
|
| Rate for Payer: Priority Health SBD |
$626.17
|
|
|
DECLOTTING BY THROMBOLYTIC AGENT OF IMPLANTED VASCULAR ACCESS DEVICE OR CATHETER
|
Facility
|
OP
|
$947.66
|
|
|
Service Code
|
CPT 36593
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$947.66 |
| Rate for Payer: Aetna Medicare |
$313.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$376.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$376.68
|
| Rate for Payer: BCBS Complete |
$173.09
|
| Rate for Payer: BCBS MAPPO |
$301.34
|
| Rate for Payer: BCBS Trust/PPO |
$207.92
|
| Rate for Payer: BCN Medicare Advantage |
$301.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.34
|
| Rate for Payer: Mclaren Medicaid |
$164.83
|
| Rate for Payer: Mclaren Medicare |
$301.34
|
| Rate for Payer: Meridian Medicaid |
$173.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$316.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.54
|
| Rate for Payer: PACE Medicare |
$286.27
|
| Rate for Payer: PACE SWMI |
$301.34
|
| Rate for Payer: PHP Medicare Advantage |
$301.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$947.66
|
| Rate for Payer: Priority Health Medicare |
$301.34
|
| Rate for Payer: Priority Health Narrow Network |
$758.13
|
| Rate for Payer: Railroad Medicare Medicare |
$301.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.46
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$301.34
|
| Rate for Payer: UHC Exchange |
$34.05
|
| Rate for Payer: UHC Medicare Advantage |
$310.38
|
| Rate for Payer: VA VA |
$301.34
|
|
|
DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC
|
Facility
|
IP
|
$19,260.24
|
|
|
Service Code
|
MS-DRG 294
|
| Min. Negotiated Rate |
$7,950.85 |
| Max. Negotiated Rate |
$19,260.24 |
| Rate for Payer: Aetna Medicare |
$8,704.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,461.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,461.65
|
| Rate for Payer: BCBS MAPPO |
$8,369.32
|
| Rate for Payer: BCBS Trust/PPO |
$19,260.24
|
| Rate for Payer: BCN Medicare Advantage |
$8,369.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,369.32
|
| Rate for Payer: Mclaren Medicare |
$8,369.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,787.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,624.72
|
| Rate for Payer: PACE Medicare |
$7,950.85
|
| Rate for Payer: PACE SWMI |
$8,369.32
|
| Rate for Payer: PHP Medicare Advantage |
$8,369.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,694.51
|
| Rate for Payer: Priority Health Medicare |
$8,369.32
|
| Rate for Payer: Priority Health Narrow Network |
$12,555.61
|
| Rate for Payer: Railroad Medicare Medicare |
$8,369.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,683.30
|
| Rate for Payer: UHC Core |
$10,237.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,369.32
|
| Rate for Payer: UHC Exchange |
$10,964.34
|
| Rate for Payer: UHC Medicare Advantage |
$8,620.40
|
| Rate for Payer: VA VA |
$8,369.32
|
|
|
DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$11,122.23
|
|
|
Service Code
|
MS-DRG 295
|
| Min. Negotiated Rate |
$5,910.84 |
| Max. Negotiated Rate |
$11,122.23 |
| Rate for Payer: Aetna Medicare |
$6,482.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,791.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,791.61
|
| Rate for Payer: BCBS MAPPO |
$6,233.29
|
| Rate for Payer: BCBS Trust/PPO |
$11,122.23
|
| Rate for Payer: BCN Medicare Advantage |
$6,233.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,233.29
|
| Rate for Payer: Mclaren Medicare |
$6,233.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,544.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,168.28
|
| Rate for Payer: PACE Medicare |
$5,921.63
|
| Rate for Payer: PACE SWMI |
$6,233.29
|
| Rate for Payer: PHP Medicare Advantage |
$6,233.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,061.97
|
| Rate for Payer: Priority Health Medicare |
$6,233.29
|
| Rate for Payer: Priority Health Narrow Network |
$7,249.58
|
| Rate for Payer: Railroad Medicare Medicare |
$6,233.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,632.90
|
| Rate for Payer: UHC Core |
$5,910.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,233.29
|
| Rate for Payer: UHC Exchange |
$6,330.79
|
| Rate for Payer: UHC Medicare Advantage |
$6,420.29
|
| Rate for Payer: VA VA |
$6,233.29
|
|
|
DEFEROXAMINE 500 MG IM INJECTION
|
Facility
|
IP
|
$143.70
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
200070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$90.53 |
| Max. Negotiated Rate |
$129.33 |
| Rate for Payer: Aetna Commercial |
$122.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.40
|
| Rate for Payer: Cash Price |
$114.96
|
| Rate for Payer: Cofinity Commercial |
$100.59
|
| Rate for Payer: Cofinity Commercial |
$123.58
|
| Rate for Payer: Healthscope Commercial |
$129.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.14
|
| Rate for Payer: PHP Commercial |
$122.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.59
|
| Rate for Payer: Priority Health SBD |
$90.53
|
|
