|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$45,839.89
|
|
|
Service Code
|
MSDRG 821
|
| Min. Negotiated Rate |
$16,985.44 |
| Max. Negotiated Rate |
$45,839.89 |
| Rate for Payer: Aetna Medicare |
$18,594.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,349.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,349.26
|
| Rate for Payer: BCBS MAPPO |
$17,879.41
|
| Rate for Payer: BCBS Trust/PPO |
$45,839.89
|
| Rate for Payer: BCN Commercial |
$45,839.89
|
| Rate for Payer: BCN Medicare Advantage |
$17,879.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,879.41
|
| Rate for Payer: Mclaren Medicare |
$17,879.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,773.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,561.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,667.35
|
| Rate for Payer: Nomi Health Commercial |
$28,877.94
|
| Rate for Payer: PACE Medicare |
$16,985.44
|
| Rate for Payer: PACE SWMI |
$17,879.41
|
| Rate for Payer: PHP Medicare Advantage |
$17,879.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$36,091.02
|
| Rate for Payer: Priority Health Medicare |
$17,879.41
|
| Rate for Payer: Priority Health Tiered Network |
$28,872.81
|
| Rate for Payer: Railroad Medicare Medicare |
$17,879.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36,489.18
|
| Rate for Payer: UHC Core |
$30,527.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,879.41
|
| Rate for Payer: UHC Exchange |
$24,931.29
|
| Rate for Payer: VA VA |
$17,879.41
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$105,289.18
|
|
|
Service Code
|
MSDRG 820
|
| Min. Negotiated Rate |
$43,608.32 |
| Max. Negotiated Rate |
$105,289.18 |
| Rate for Payer: Aetna Medicare |
$47,739.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57,379.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57,379.38
|
| Rate for Payer: BCBS MAPPO |
$45,903.50
|
| Rate for Payer: BCBS Trust/PPO |
$105,289.18
|
| Rate for Payer: BCN Commercial |
$105,289.18
|
| Rate for Payer: BCN Medicare Advantage |
$45,903.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45,903.50
|
| Rate for Payer: Mclaren Medicare |
$45,903.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48,198.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52,789.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$50,493.85
|
| Rate for Payer: Nomi Health Commercial |
$75,655.92
|
| Rate for Payer: PACE Medicare |
$43,608.32
|
| Rate for Payer: PACE SWMI |
$45,903.50
|
| Rate for Payer: PHP Medicare Advantage |
$45,903.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$94,553.13
|
| Rate for Payer: Priority Health Medicare |
$45,903.50
|
| Rate for Payer: Priority Health Tiered Network |
$75,642.49
|
| Rate for Payer: Railroad Medicare Medicare |
$45,903.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95,596.24
|
| Rate for Payer: UHC Core |
$79,978.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$45,903.50
|
| Rate for Payer: UHC Exchange |
$65,316.28
|
| Rate for Payer: VA VA |
$45,903.50
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$31,755.29
|
|
|
Service Code
|
MSDRG 822
|
| Min. Negotiated Rate |
$9,389.59 |
| Max. Negotiated Rate |
$31,755.29 |
| Rate for Payer: Aetna Medicare |
$10,279.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,354.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,354.73
|
| Rate for Payer: BCBS MAPPO |
$9,883.78
|
| Rate for Payer: BCBS Trust/PPO |
$31,755.29
|
| Rate for Payer: BCN Commercial |
$31,755.29
|
| Rate for Payer: BCN Medicare Advantage |
$9,883.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,883.78
|
| Rate for Payer: Mclaren Medicare |
$9,883.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,377.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,366.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,872.16
|
| Rate for Payer: Nomi Health Commercial |
$15,531.60
|
| Rate for Payer: PACE Medicare |
$9,389.59
|
| Rate for Payer: PACE SWMI |
$9,883.78
|
| Rate for Payer: PHP Medicare Advantage |
$9,883.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,411.06
|
| Rate for Payer: Priority Health Medicare |
$9,883.78
|
| Rate for Payer: Priority Health Tiered Network |
$15,528.84
|
| Rate for Payer: Railroad Medicare Medicare |
$9,883.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,625.20
|
| Rate for Payer: UHC Core |
$16,418.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,883.78
|
| Rate for Payer: UHC Exchange |
$13,408.95
|
| Rate for Payer: VA VA |
$9,883.78
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC
|
Facility
|
IP
|
$33,585.80
|
|
|
Service Code
|
MSDRG 841
|
| Min. Negotiated Rate |
$12,527.49 |
| Max. Negotiated Rate |
$33,585.80 |
| Rate for Payer: Aetna Medicare |
$13,714.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,483.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,483.54
|
| Rate for Payer: BCBS MAPPO |
$13,186.83
|
| Rate for Payer: BCBS Trust/PPO |
$33,585.80
|
| Rate for Payer: BCN Commercial |
$33,585.80
|
| Rate for Payer: BCN Medicare Advantage |
$13,186.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,186.83
|
| Rate for Payer: Mclaren Medicare |
$13,186.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,846.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,164.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,505.51
|
| Rate for Payer: Nomi Health Commercial |
$21,045.06
|
| Rate for Payer: PACE Medicare |
$12,527.49
|
| Rate for Payer: PACE SWMI |
$13,186.83
|
| Rate for Payer: PHP Medicare Advantage |
$13,186.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,301.66
|
| Rate for Payer: Priority Health Medicare |
$13,186.83
|
| Rate for Payer: Priority Health Tiered Network |
$21,041.32
|
| Rate for Payer: Railroad Medicare Medicare |
$13,186.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,591.82
|
| Rate for Payer: UHC Core |
$22,247.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,186.83
|
| Rate for Payer: UHC Exchange |
$18,168.90
|
| Rate for Payer: VA VA |
$13,186.83
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC
|
Facility
|
IP
|
$71,600.39
|
|
|
Service Code
|
MSDRG 840
|
| Min. Negotiated Rate |
$24,300.10 |
| Max. Negotiated Rate |
$71,600.39 |
| Rate for Payer: Aetna Medicare |
$26,602.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,973.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,973.81
|
| Rate for Payer: BCBS MAPPO |
$25,579.05
|
| Rate for Payer: BCBS Trust/PPO |
$71,600.39
|
| Rate for Payer: BCN Commercial |
$71,600.39
|
| Rate for Payer: BCN Medicare Advantage |
$25,579.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,579.05
|
| Rate for Payer: Mclaren Medicare |
$25,579.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26,858.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,415.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$28,136.96
|
| Rate for Payer: Nomi Health Commercial |
$41,730.21
|
| Rate for Payer: PACE Medicare |
$24,300.10
|
| Rate for Payer: PACE SWMI |
$25,579.05
|
| Rate for Payer: PHP Medicare Advantage |
$25,579.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$52,153.51
|
| Rate for Payer: Priority Health Medicare |
$25,579.05
|
| Rate for Payer: Priority Health Tiered Network |
$41,722.80
|
| Rate for Payer: Railroad Medicare Medicare |
$25,579.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52,728.87
|
| Rate for Payer: UHC Core |
$44,114.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25,579.05
|
| Rate for Payer: UHC Exchange |
$36,027.08
|
| Rate for Payer: VA VA |
$25,579.05
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC
|
Facility
|
IP
|
$43,672.31
|
|
|
Service Code
|
MSDRG 824
|
| Min. Negotiated Rate |
$17,183.67 |
| Max. Negotiated Rate |
$43,672.31 |
| Rate for Payer: Aetna Medicare |
$18,811.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,610.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,610.09
|
| Rate for Payer: BCBS MAPPO |
$18,088.07
|
| Rate for Payer: BCBS Trust/PPO |
$43,672.31
|
| Rate for Payer: BCN Commercial |
$43,672.31
|
| Rate for Payer: BCN Medicare Advantage |
$18,088.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,088.07
|
| Rate for Payer: Mclaren Medicare |
$18,088.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,992.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,801.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,896.88
|
| Rate for Payer: Nomi Health Commercial |
$29,226.24
|
| Rate for Payer: PACE Medicare |
$17,183.67
|
| Rate for Payer: PACE SWMI |
$18,088.07
|
| Rate for Payer: PHP Medicare Advantage |
$18,088.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$36,526.32
|
| Rate for Payer: Priority Health Medicare |
$18,088.07
|
| Rate for Payer: Priority Health Tiered Network |
$29,221.05
|
| Rate for Payer: Railroad Medicare Medicare |
$18,088.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36,929.28
|
| Rate for Payer: UHC Core |
$30,895.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,088.07
|
| Rate for Payer: UHC Exchange |
$25,231.99
|
| Rate for Payer: VA VA |
$18,088.07
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC
|
Facility
|
IP
|
$89,289.82
|
|
|
Service Code
|
MSDRG 823
|
| Min. Negotiated Rate |
$34,210.81 |
| Max. Negotiated Rate |
$89,289.82 |
| Rate for Payer: Aetna Medicare |
$37,451.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45,014.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45,014.22
|
| Rate for Payer: BCBS MAPPO |
$36,011.38
|
| Rate for Payer: BCBS Trust/PPO |
$89,289.82
|
| Rate for Payer: BCN Commercial |
$89,289.82
|
| Rate for Payer: BCN Medicare Advantage |
$36,011.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36,011.38
|
| Rate for Payer: Mclaren Medicare |
$36,011.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37,811.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,413.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$39,612.52
|
| Rate for Payer: Nomi Health Commercial |
$59,143.92
|
| Rate for Payer: PACE Medicare |
$34,210.81
|
| Rate for Payer: PACE SWMI |
$36,011.38
|
| Rate for Payer: PHP Medicare Advantage |
$36,011.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$73,916.79
|
| Rate for Payer: Priority Health Medicare |
$36,011.38
|
| Rate for Payer: Priority Health Tiered Network |
$59,133.42
|
| Rate for Payer: Railroad Medicare Medicare |
$36,011.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74,732.24
|
| Rate for Payer: UHC Core |
$62,522.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$36,011.38
|
| Rate for Payer: UHC Exchange |
$51,060.92
|
| Rate for Payer: VA VA |
$36,011.38
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$36,565.64
|
|
|
Service Code
|
MSDRG 825
|
| Min. Negotiated Rate |
$10,457.12 |
| Max. Negotiated Rate |
$36,565.64 |
| Rate for Payer: Aetna Medicare |
$11,447.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,759.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,759.36
|
| Rate for Payer: BCBS MAPPO |
$11,007.49
|
| Rate for Payer: BCBS Trust/PPO |
$36,565.64
|
| Rate for Payer: BCN Commercial |
$36,565.64
|
| Rate for Payer: BCN Medicare Advantage |
$11,007.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,007.49
|
| Rate for Payer: Mclaren Medicare |
$11,007.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,557.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,658.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,108.24
|
| Rate for Payer: Nomi Health Commercial |
$17,407.26
|
| Rate for Payer: PACE Medicare |
$10,457.12
|
| Rate for Payer: PACE SWMI |
$11,007.49
|
| Rate for Payer: PHP Medicare Advantage |
$11,007.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,755.22
|
| Rate for Payer: Priority Health Medicare |
$11,007.49
|
| Rate for Payer: Priority Health Tiered Network |
$17,404.17
|
| Rate for Payer: Railroad Medicare Medicare |
$11,007.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,995.22
|
| Rate for Payer: UHC Core |
$18,401.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,007.49
|
| Rate for Payer: UHC Exchange |
$15,028.27
|
| Rate for Payer: VA VA |
$11,007.49
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC
|
Facility
|
IP
|
$21,392.57
|
|
|
Service Code
|
MSDRG 842
|
| Min. Negotiated Rate |
$7,968.22 |
| Max. Negotiated Rate |
$21,392.57 |
| Rate for Payer: Aetna Medicare |
$8,723.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,484.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,484.50
|
| Rate for Payer: BCBS MAPPO |
$8,387.60
|
| Rate for Payer: BCBS Trust/PPO |
$21,392.57
|
| Rate for Payer: BCN Commercial |
$21,392.57
|
| Rate for Payer: BCN Medicare Advantage |
$8,387.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,387.60
|
| Rate for Payer: Mclaren Medicare |
$8,387.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,806.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,645.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,226.36
|
| Rate for Payer: Nomi Health Commercial |
$13,034.16
|
| Rate for Payer: PACE Medicare |
$7,968.22
|
| Rate for Payer: PACE SWMI |
$8,387.60
|
| Rate for Payer: PHP Medicare Advantage |
$8,387.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,289.81
|
| Rate for Payer: Priority Health Medicare |
$8,387.60
|
| Rate for Payer: Priority Health Tiered Network |
$13,031.85
|
| Rate for Payer: Railroad Medicare Medicare |
$8,387.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,469.52
|
| Rate for Payer: UHC Core |
$13,778.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,387.60
|
| Rate for Payer: UHC Exchange |
$11,252.82
|
| Rate for Payer: VA VA |
$8,387.60
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$21,228.73
|
|
|
Service Code
|
APR-DRG 6914
|
| Min. Negotiated Rate |
$20,217.83 |
| Max. Negotiated Rate |
$21,228.73 |
| Rate for Payer: BCBS Complete |
$21,228.73
|
| Rate for Payer: Mclaren Medicaid |
$20,217.83
|
| Rate for Payer: Meridian Medicaid |
$21,228.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,217.83
|
| Rate for Payer: UHC Medicaid |
$20,217.83
|
| Rate for Payer: UHCCP Medicaid |
$20,217.83
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$8,210.80
|
|
|
Service Code
|
APR-DRG 6912
|
| Min. Negotiated Rate |
$7,819.81 |
| Max. Negotiated Rate |
$8,210.80 |
| Rate for Payer: BCBS Complete |
$8,210.80
|
| Rate for Payer: Mclaren Medicaid |
$7,819.81
|
| Rate for Payer: Meridian Medicaid |
$8,210.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,819.81
|
| Rate for Payer: UHC Medicaid |
$7,819.81
|
| Rate for Payer: UHCCP Medicaid |
$7,819.81
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$15,857.48
|
|
|
Service Code
|
APR-DRG 6913
|
| Min. Negotiated Rate |
$15,102.36 |
| Max. Negotiated Rate |
$15,857.48 |
| Rate for Payer: BCBS Complete |
$15,857.48
|
| Rate for Payer: Mclaren Medicaid |
$15,102.36
|
| Rate for Payer: Meridian Medicaid |
$15,857.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,102.36
|
| Rate for Payer: UHC Medicaid |
$15,102.36
|
| Rate for Payer: UHCCP Medicaid |
$15,102.36
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$4,854.70
|
|
|
Service Code
|
APR-DRG 6911
|
| Min. Negotiated Rate |
$4,623.53 |
| Max. Negotiated Rate |
$4,854.70 |
| Rate for Payer: BCBS Complete |
$4,854.70
|
| Rate for Payer: Mclaren Medicaid |
$4,623.53
|
| Rate for Payer: Meridian Medicaid |
$4,854.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,623.53
|
| Rate for Payer: UHC Medicaid |
$4,623.53
|
| Rate for Payer: UHCCP Medicaid |
$4,623.53
|
|
|
LYSIS OR EXCISION OF PENILE POST-CIRCUMCISION ADHESIONS
|
Facility
|
OP
|
$6,735.82
|
|
|
Service Code
|
CPT 54162
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,384.78
|
| Rate for Payer: BCN Commercial |
$1,384.78
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Mclaren Medicaid |
$1,089.34
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
IP
|
$17.32
|
|
|
Service Code
|
NDC 71399005101
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$15.59 |
| Rate for Payer: Aetna Commercial |
$14.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.26
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cofinity Advantage |
$12.12
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$15.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.99
|
| Rate for Payer: PHP Commercial |
$14.72
|
| Rate for Payer: Priority Health SBD |
$10.91
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
IP
|
$17.32
|
|
|
Service Code
|
NDC 71399788901
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$15.59 |
| Rate for Payer: Aetna Commercial |
$14.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.26
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cofinity Advantage |
$12.12
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$15.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.99
|
| Rate for Payer: PHP Commercial |
$14.72
|
| Rate for Payer: Priority Health SBD |
$10.91
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
OP
|
$17.32
|
|
|
Service Code
|
NDC 71399005101
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$15.59 |
| Rate for Payer: Aetna Commercial |
$14.72
|
| Rate for Payer: Aetna Medicare |
$8.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.26
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cofinity Advantage |
$12.12
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$15.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.99
|
| Rate for Payer: PHP Commercial |
$14.72
|
| Rate for Payer: Priority Health SBD |
$10.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.26
|
| Rate for Payer: UHC Core |
$9.02
|
| Rate for Payer: UHC Exchange |
$6.81
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
OP
|
$17.32
|
|
|
Service Code
|
NDC 71399788901
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$15.59 |
| Rate for Payer: Aetna Commercial |
$14.72
|
| Rate for Payer: Aetna Medicare |
$8.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.26
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cofinity Advantage |
$12.12
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$15.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.99
|
| Rate for Payer: PHP Commercial |
$14.72
|
| Rate for Payer: Priority Health SBD |
$10.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.26
|
| Rate for Payer: UHC Core |
$9.02
|
| Rate for Payer: UHC Exchange |
$6.81
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
OP
|
$8.88
|
|
|
Service Code
|
NDC 70000066001
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Aetna Commercial |
$7.55
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.77
|
| Rate for Payer: BCBS Complete |
$3.55
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Advantage |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$7.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.66
|
| Rate for Payer: PHP Commercial |
$7.55
|
| Rate for Payer: Priority Health SBD |
$5.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.77
|
| Rate for Payer: UHC Core |
$4.63
|
| Rate for Payer: UHC Exchange |
$3.49
|
|
|
MAGNESIUM CITRATE ORAL SOLUTION
|
Facility
|
IP
|
$8.88
|
|
|
Service Code
|
NDC 70000066001
|
| Hospital Charge Code |
4712
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Aetna Commercial |
$7.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.77
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Advantage |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$7.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.66
|
| Rate for Payer: PHP Commercial |
$7.55
|
| Rate for Payer: Priority Health SBD |
$5.59
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$5.91
|
|
|
Service Code
|
NDC 00121043130
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna Commercial |
$5.02
|
| Rate for Payer: Aetna Medicare |
$2.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.84
|
| Rate for Payer: BCBS Complete |
$2.36
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cofinity Advantage |
$4.14
|
| Rate for Payer: Cofinity Commercial |
$5.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.73
|
| Rate for Payer: Healthscope Commercial |
$5.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.43
|
| Rate for Payer: PHP Commercial |
$5.02
|
| Rate for Payer: Priority Health SBD |
$3.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.84
|
| Rate for Payer: UHC Core |
$3.08
|
| Rate for Payer: UHC Exchange |
$2.32
|
|
|
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$5.91
|
|
|
Service Code
|
NDC 00121043130
|
| Hospital Charge Code |
108978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna Commercial |
$5.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.84
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cofinity Advantage |
$4.14
|
| Rate for Payer: Cofinity Commercial |
$5.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.73
|
| Rate for Payer: Healthscope Commercial |
$5.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.43
|
| Rate for Payer: PHP Commercial |
$5.02
|
| Rate for Payer: Priority Health SBD |
$3.72
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
NDC 64980033990
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Aetna Commercial |
$0.92
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.70
|
| Rate for Payer: BCBS Complete |
$0.43
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cofinity Advantage |
$0.76
|
| Rate for Payer: Cofinity Commercial |
$0.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.86
|
| Rate for Payer: Healthscope Commercial |
$0.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.81
|
| Rate for Payer: PHP Commercial |
$0.92
|
| Rate for Payer: Priority Health SBD |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.70
|
| Rate for Payer: UHC Core |
$0.56
|
| Rate for Payer: UHC Exchange |
$0.42
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
NDC 60258017101
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.91 |
| Max. Negotiated Rate |
$345.60 |
| Rate for Payer: Aetna Commercial |
$326.40
|
| Rate for Payer: Aetna Medicare |
$192.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.60
|
| Rate for Payer: BCBS Complete |
$153.60
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cofinity Advantage |
$268.80
|
| Rate for Payer: Cofinity Commercial |
$330.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.20
|
| Rate for Payer: Healthscope Commercial |
$345.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$307.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.00
|
| Rate for Payer: PHP Commercial |
$326.40
|
| Rate for Payer: Priority Health SBD |
$241.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.60
|
| Rate for Payer: UHC Core |
$200.06
|
| Rate for Payer: UHC Exchange |
$150.91
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
NDC 37864078599
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.88 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$149.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.40
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Advantage |
$123.20
|
| Rate for Payer: Cofinity Commercial |
$151.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.80
|
| Rate for Payer: Healthscope Commercial |
$158.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.00
|
| Rate for Payer: PHP Commercial |
$149.60
|
| Rate for Payer: Priority Health SBD |
$110.88
|
|
