|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$53.54
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$48.19 |
| Rate for Payer: Aetna Commercial |
$45.51
|
| Rate for Payer: Aetna Commercial |
$122.14
|
| Rate for Payer: Aetna Commercial |
$31.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.80
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cash Price |
$42.83
|
| Rate for Payer: Cash Price |
$114.96
|
| Rate for Payer: Cofinity Commercial |
$46.04
|
| Rate for Payer: Cofinity Commercial |
$100.59
|
| Rate for Payer: Cofinity Commercial |
$123.58
|
| Rate for Payer: Cofinity Commercial |
$25.89
|
| Rate for Payer: Cofinity Commercial |
$31.80
|
| Rate for Payer: Cofinity Commercial |
$37.48
|
| Rate for Payer: Healthscope Commercial |
$129.33
|
| Rate for Payer: Healthscope Commercial |
$48.19
|
| Rate for Payer: Healthscope Commercial |
$33.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.43
|
| Rate for Payer: PHP Commercial |
$45.51
|
| Rate for Payer: PHP Commercial |
$31.43
|
| Rate for Payer: PHP Commercial |
$122.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.48
|
| Rate for Payer: Priority Health SBD |
$90.53
|
| Rate for Payer: Priority Health SBD |
$33.73
|
| Rate for Payer: Priority Health SBD |
$23.30
|
|
|
DEGARELIX 120 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$4,535.97
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
96987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,857.66 |
| Max. Negotiated Rate |
$4,082.37 |
| Rate for Payer: Aetna Commercial |
$3,855.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,948.38
|
| Rate for Payer: Cash Price |
$3,628.78
|
| Rate for Payer: Cofinity Commercial |
$3,175.18
|
| Rate for Payer: Cofinity Commercial |
$3,900.93
|
| Rate for Payer: Healthscope Commercial |
$4,082.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,855.57
|
| Rate for Payer: PHP Commercial |
$3,855.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,175.18
|
| Rate for Payer: Priority Health SBD |
$2,857.66
|
|
|
DEGARELIX 120 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$4,535.97
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
96987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$4,082.37 |
| Rate for Payer: Aetna Commercial |
$3,855.57
|
| Rate for Payer: Aetna Medicare |
$4.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,948.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.23
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS MAPPO |
$4.19
|
| Rate for Payer: BCBS Trust/PPO |
$12.38
|
| Rate for Payer: BCN Medicare Advantage |
$4.19
|
| Rate for Payer: Cash Price |
$3,628.78
|
| Rate for Payer: Cash Price |
$3,628.78
|
| Rate for Payer: Cofinity Commercial |
$3,175.18
|
| Rate for Payer: Cofinity Commercial |
$3,900.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.19
|
| Rate for Payer: Healthscope Commercial |
$4,082.37
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.19
|
| Rate for Payer: Meridian Medicaid |
$2.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,855.57
|
| Rate for Payer: PACE Medicare |
$3.98
|
| Rate for Payer: PACE SWMI |
$4.19
|
| Rate for Payer: PHP Commercial |
$3,855.57
|
| Rate for Payer: PHP Medicare Advantage |
$4.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,175.18
|
| Rate for Payer: Priority Health Medicare |
$4.19
|
| Rate for Payer: Priority Health SBD |
$2,857.66
|
| Rate for Payer: Railroad Medicare Medicare |
$4.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.19
|
| Rate for Payer: UHC Medicare Advantage |
$4.31
|
| Rate for Payer: VA VA |
$4.19
|
|
|
DEGARELIX 80 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$1,453.64
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
96986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$1,308.28 |
| Rate for Payer: Aetna Commercial |
$1,235.59
|
| Rate for Payer: Aetna Medicare |
$4.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$944.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.23
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS MAPPO |
$4.19
|
| Rate for Payer: BCBS Trust/PPO |
$12.38
|
| Rate for Payer: BCN Medicare Advantage |
$4.19
|
| Rate for Payer: Cash Price |
$1,162.91
|
| Rate for Payer: Cash Price |
$1,162.91
|
| Rate for Payer: Cofinity Commercial |
$1,250.13
|
| Rate for Payer: Cofinity Commercial |
$1,017.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.19
|
| Rate for Payer: Healthscope Commercial |
$1,308.28
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.19
|
| Rate for Payer: Meridian Medicaid |
$2.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,235.59
|
| Rate for Payer: PACE Medicare |
$3.98
|
| Rate for Payer: PACE SWMI |
$4.19
|
| Rate for Payer: PHP Commercial |
$1,235.59
|
| Rate for Payer: PHP Medicare Advantage |
$4.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,017.55
|
| Rate for Payer: Priority Health Medicare |
$4.19
|
| Rate for Payer: Priority Health SBD |
$915.79
|
| Rate for Payer: Railroad Medicare Medicare |
$4.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.19
|
| Rate for Payer: UHC Medicare Advantage |
$4.31
|
| Rate for Payer: VA VA |
$4.19
|
|
|
DEGARELIX 80 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$1,453.64
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
96986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$915.79 |
| Max. Negotiated Rate |
$1,308.28 |
| Rate for Payer: Aetna Commercial |
$1,235.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$944.87
|
| Rate for Payer: Cash Price |
$1,162.91
|
| Rate for Payer: Cofinity Commercial |
$1,017.55
|
| Rate for Payer: Cofinity Commercial |
$1,250.13
|
| Rate for Payer: Healthscope Commercial |
$1,308.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,235.59
|
| Rate for Payer: PHP Commercial |
$1,235.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,017.55
|
| Rate for Payer: Priority Health SBD |
$915.79
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$39,956.60
|
|
|
Service Code
|
MS-DRG 056
|
| Min. Negotiated Rate |
$16,847.13 |
| Max. Negotiated Rate |
$39,956.60 |
| Rate for Payer: Aetna Medicare |
$18,443.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,167.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,167.28
|
| Rate for Payer: BCBS MAPPO |
$17,733.82
|
| Rate for Payer: BCBS Trust/PPO |
$39,956.60
|
| Rate for Payer: BCN Medicare Advantage |
$17,733.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,733.82
|
| Rate for Payer: Mclaren Medicare |
$17,733.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,620.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,393.89
|
| Rate for Payer: PACE Medicare |
$16,847.13
|
| Rate for Payer: PACE SWMI |
$17,733.82
|
| Rate for Payer: PHP Medicare Advantage |
$17,733.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,353.71
|
| Rate for Payer: Priority Health Medicare |
$17,733.82
|
| Rate for Payer: Priority Health Narrow Network |
$27,482.97
|
| Rate for Payer: Railroad Medicare Medicare |
$17,733.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36,518.08
|
| Rate for Payer: UHC Core |
$22,407.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,733.82
|
| Rate for Payer: UHC Exchange |
$23,999.85
|
| Rate for Payer: UHC Medicare Advantage |
$18,265.83
|
| Rate for Payer: VA VA |
$17,733.82
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$29,429.45
|
|
|
Service Code
|
MS-DRG 057
|
| Min. Negotiated Rate |
$9,794.71 |
| Max. Negotiated Rate |
$29,429.45 |
| Rate for Payer: Aetna Medicare |
$10,722.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,887.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,887.78
|
| Rate for Payer: BCBS MAPPO |
$10,310.22
|
| Rate for Payer: BCBS Trust/PPO |
$29,429.45
|
| Rate for Payer: BCN Medicare Advantage |
$10,310.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,310.22
|
| Rate for Payer: Mclaren Medicare |
$10,310.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,825.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,856.75
|
| Rate for Payer: PACE Medicare |
$9,794.71
|
| Rate for Payer: PACE SWMI |
$10,310.22
|
| Rate for Payer: PHP Medicare Advantage |
$10,310.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,561.81
|
| Rate for Payer: Priority Health Medicare |
$10,310.22
|
| Rate for Payer: Priority Health Narrow Network |
$15,649.45
|
| Rate for Payer: Railroad Medicare Medicare |
$10,310.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,794.25
|
| Rate for Payer: UHC Core |
$12,759.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,310.22
|
| Rate for Payer: UHC Exchange |
$13,666.08
|
| Rate for Payer: UHC Medicare Advantage |
$10,619.53
|
| Rate for Payer: VA VA |
$10,310.22
|
|
|
DEIONIZED WATER
|
Facility
|
IP
|
$889.48
|
|
|
Service Code
|
NDC 0990-0000-39
|
| Hospital Charge Code |
150892
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$560.37 |
| Max. Negotiated Rate |
$800.53 |
| Rate for Payer: Aetna Commercial |
$756.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.16
|
| Rate for Payer: Cash Price |
$711.58
|
| Rate for Payer: Cofinity Commercial |
$622.64
|
| Rate for Payer: Cofinity Commercial |
$764.95
|
| Rate for Payer: Healthscope Commercial |
$800.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$756.06
|
| Rate for Payer: PHP Commercial |
$756.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.64
|
| Rate for Payer: Priority Health SBD |
$560.37
|
|
|
DELAYED CREATION OF EXIT SITE FROM EMBEDDED SUBCUTANEOUS SEGMENT OF INTRAPERITONEAL CANNULA OR CATHETER
|
Facility
|
OP
|
$5,222.22
|
|
|
Service Code
|
CPT 49436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$183.69 |
| Max. Negotiated Rate |
$5,222.22 |
| Rate for Payer: Aetna Medicare |
$1,760.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,116.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,116.40
|
| Rate for Payer: BCBS Complete |
$972.53
|
| Rate for Payer: BCBS MAPPO |
$1,693.12
|
| Rate for Payer: BCBS Trust/PPO |
$615.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,693.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,693.12
|
| Rate for Payer: Mclaren Medicaid |
$926.14
|
| Rate for Payer: Mclaren Medicare |
$1,693.12
|
| Rate for Payer: Meridian Medicaid |
$972.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,777.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,947.09
|
| Rate for Payer: PACE Medicare |
$1,608.46
|
| Rate for Payer: PACE SWMI |
$1,693.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,693.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$926.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,222.22
|
| Rate for Payer: Priority Health Medicare |
$1,693.12
|
| Rate for Payer: Priority Health Narrow Network |
$4,177.77
|
| Rate for Payer: Railroad Medicare Medicare |
$1,693.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.06
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,693.12
|
| Rate for Payer: UHC Exchange |
$183.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,743.91
|
| Rate for Payer: VA VA |
$1,693.12
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$7,723.36
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
106804
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,865.72 |
| Max. Negotiated Rate |
$6,951.02 |
| Rate for Payer: Aetna Commercial |
$6,564.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,020.18
|
| Rate for Payer: Cash Price |
$6,178.69
|
| Rate for Payer: Cofinity Commercial |
$5,406.35
|
| Rate for Payer: Cofinity Commercial |
$6,642.09
|
| Rate for Payer: Healthscope Commercial |
$6,951.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,564.86
|
| Rate for Payer: PHP Commercial |
$6,564.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,406.35
|
| Rate for Payer: Priority Health SBD |
$4,865.72
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$7,723.36
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
106804
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$6,951.02 |
| Rate for Payer: Aetna Commercial |
$6,564.86
|
| Rate for Payer: Aetna Medicare |
$26.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,020.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.50
|
| Rate for Payer: BCBS Complete |
$14.47
|
| Rate for Payer: BCBS MAPPO |
$25.20
|
| Rate for Payer: BCBS Trust/PPO |
$74.59
|
| Rate for Payer: BCN Medicare Advantage |
$25.20
|
| Rate for Payer: Cash Price |
$6,178.69
|
| Rate for Payer: Cash Price |
$6,178.69
|
| Rate for Payer: Cofinity Commercial |
$6,642.09
|
| Rate for Payer: Cofinity Commercial |
$5,406.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.20
|
| Rate for Payer: Healthscope Commercial |
$6,951.02
|
| Rate for Payer: Mclaren Medicaid |
$13.78
|
| Rate for Payer: Mclaren Medicare |
$25.20
|
| Rate for Payer: Meridian Medicaid |
$14.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,564.86
|
| Rate for Payer: PACE Medicare |
$23.94
|
| Rate for Payer: PACE SWMI |
$25.20
|
| Rate for Payer: PHP Commercial |
$6,564.86
|
| Rate for Payer: PHP Medicare Advantage |
$25.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,406.35
|
| Rate for Payer: Priority Health Medicare |
$25.20
|
| Rate for Payer: Priority Health SBD |
$4,865.72
|
| Rate for Payer: Railroad Medicare Medicare |
$25.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.20
|
| Rate for Payer: UHC Medicare Advantage |
$25.95
|
| Rate for Payer: VA VA |
$25.20
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$5,168.23
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
105502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,255.98 |
| Max. Negotiated Rate |
$4,651.41 |
| Rate for Payer: Aetna Commercial |
$4,393.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,359.35
|
| Rate for Payer: Cash Price |
$4,134.58
|
| Rate for Payer: Cofinity Commercial |
$3,617.76
|
| Rate for Payer: Cofinity Commercial |
$4,444.68
|
| Rate for Payer: Healthscope Commercial |
$4,651.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,393.00
|
| Rate for Payer: PHP Commercial |
$4,393.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,617.76
|
| Rate for Payer: Priority Health SBD |
$3,255.98
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$5,168.23
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
105502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$4,651.41 |
| Rate for Payer: Aetna Commercial |
$4,393.00
|
| Rate for Payer: Aetna Medicare |
$26.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,359.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.50
|
| Rate for Payer: BCBS Complete |
$14.47
|
| Rate for Payer: BCBS MAPPO |
$25.20
|
| Rate for Payer: BCBS Trust/PPO |
$74.59
|
| Rate for Payer: BCN Medicare Advantage |
$25.20
|
| Rate for Payer: Cash Price |
$4,134.58
|
| Rate for Payer: Cash Price |
$4,134.58
|
| Rate for Payer: Cofinity Commercial |
$4,444.68
|
| Rate for Payer: Cofinity Commercial |
$3,617.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.20
|
| Rate for Payer: Healthscope Commercial |
$4,651.41
|
| Rate for Payer: Mclaren Medicaid |
$13.78
|
| Rate for Payer: Mclaren Medicare |
$25.20
|
| Rate for Payer: Meridian Medicaid |
$14.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,393.00
|
| Rate for Payer: PACE Medicare |
$23.94
|
| Rate for Payer: PACE SWMI |
$25.20
|
| Rate for Payer: PHP Commercial |
$4,393.00
|
| Rate for Payer: PHP Medicare Advantage |
$25.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,617.76
|
| Rate for Payer: Priority Health Medicare |
$25.20
|
| Rate for Payer: Priority Health SBD |
$3,255.98
|
| Rate for Payer: Railroad Medicare Medicare |
$25.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.20
|
| Rate for Payer: UHC Medicare Advantage |
$25.95
|
| Rate for Payer: VA VA |
$25.20
|
|
|
DENTAL AND ORAL DISEASES WITH CC
|
Facility
|
IP
|
$16,495.60
|
|
|
Service Code
|
MS-DRG 158
|
| Min. Negotiated Rate |
$6,889.05 |
| Max. Negotiated Rate |
$16,495.60 |
| Rate for Payer: Aetna Medicare |
$7,541.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,064.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,064.54
|
| Rate for Payer: BCBS MAPPO |
$7,251.63
|
| Rate for Payer: BCBS Trust/PPO |
$16,495.60
|
| Rate for Payer: BCN Medicare Advantage |
$7,251.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,251.63
|
| Rate for Payer: Mclaren Medicare |
$7,251.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,614.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,339.37
|
| Rate for Payer: PACE Medicare |
$6,889.05
|
| Rate for Payer: PACE SWMI |
$7,251.63
|
| Rate for Payer: PHP Medicare Advantage |
$7,251.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,467.40
|
| Rate for Payer: Priority Health Medicare |
$7,251.63
|
| Rate for Payer: Priority Health Narrow Network |
$10,773.92
|
| Rate for Payer: Railroad Medicare Medicare |
$7,251.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,315.88
|
| Rate for Payer: UHC Core |
$8,784.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,251.63
|
| Rate for Payer: UHC Exchange |
$9,408.46
|
| Rate for Payer: UHC Medicare Advantage |
$7,469.18
|
| Rate for Payer: VA VA |
$7,251.63
|
|
|
DENTAL AND ORAL DISEASES WITH MCC
|
Facility
|
IP
|
$45,160.88
|
|
|
Service Code
|
MS-DRG 157
|
| Min. Negotiated Rate |
$12,146.86 |
| Max. Negotiated Rate |
$45,160.88 |
| Rate for Payer: Aetna Medicare |
$13,297.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,982.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,982.71
|
| Rate for Payer: BCBS MAPPO |
$12,786.17
|
| Rate for Payer: BCBS Trust/PPO |
$45,160.88
|
| Rate for Payer: BCN Medicare Advantage |
$12,786.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,786.17
|
| Rate for Payer: Mclaren Medicare |
$12,786.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,425.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,704.10
|
| Rate for Payer: PACE Medicare |
$12,146.86
|
| Rate for Payer: PACE SWMI |
$12,786.17
|
| Rate for Payer: PHP Medicare Advantage |
$12,786.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,495.31
|
| Rate for Payer: Priority Health Medicare |
$12,786.17
|
| Rate for Payer: Priority Health Narrow Network |
$19,596.25
|
| Rate for Payer: Railroad Medicare Medicare |
$12,786.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,038.58
|
| Rate for Payer: UHC Core |
$15,977.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,786.17
|
| Rate for Payer: UHC Exchange |
$17,112.68
|
| Rate for Payer: UHC Medicare Advantage |
$13,169.76
|
| Rate for Payer: VA VA |
$12,786.17
|
|
|
DENTAL AND ORAL DISEASES WITHOUT CC/MCC
|
Facility
|
IP
|
$12,068.67
|
|
|
Service Code
|
MS-DRG 159
|
| Min. Negotiated Rate |
$5,087.61 |
| Max. Negotiated Rate |
$12,068.67 |
| Rate for Payer: Aetna Medicare |
$5,569.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,694.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,694.22
|
| Rate for Payer: BCBS MAPPO |
$5,355.38
|
| Rate for Payer: BCBS Trust/PPO |
$12,068.67
|
| Rate for Payer: BCN Medicare Advantage |
$5,355.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,355.38
|
| Rate for Payer: Mclaren Medicare |
$5,355.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,623.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,158.69
|
| Rate for Payer: PACE Medicare |
$5,087.61
|
| Rate for Payer: PACE SWMI |
$5,355.38
|
| Rate for Payer: PHP Medicare Advantage |
$5,355.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,689.07
|
| Rate for Payer: Priority Health Medicare |
$5,355.38
|
| Rate for Payer: Priority Health Narrow Network |
$7,751.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,355.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,299.50
|
| Rate for Payer: UHC Core |
$6,319.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,355.38
|
| Rate for Payer: UHC Exchange |
$6,768.88
|
| Rate for Payer: UHC Medicare Advantage |
$5,516.04
|
| Rate for Payer: VA VA |
$5,355.38
|
|
|
DEPRESSIVE NEUROSES
|
Facility
|
IP
|
$13,827.75
|
|
|
Service Code
|
MS-DRG 881
|
| Min. Negotiated Rate |
$6,670.09 |
| Max. Negotiated Rate |
$13,827.75 |
| Rate for Payer: Aetna Medicare |
$7,302.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,776.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,776.44
|
| Rate for Payer: BCBS MAPPO |
$7,021.15
|
| Rate for Payer: BCBS Trust/PPO |
$9,174.47
|
| Rate for Payer: BCN Medicare Advantage |
$7,021.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,021.15
|
| Rate for Payer: Mclaren Medicare |
$7,021.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,372.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,074.32
|
| Rate for Payer: PACE Medicare |
$6,670.09
|
| Rate for Payer: PACE SWMI |
$7,021.15
|
| Rate for Payer: PHP Medicare Advantage |
$7,021.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,008.20
|
| Rate for Payer: Priority Health Medicare |
$7,021.15
|
| Rate for Payer: Priority Health Narrow Network |
$10,406.56
|
| Rate for Payer: Railroad Medicare Medicare |
$7,021.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,827.75
|
| Rate for Payer: UHC Core |
$8,484.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,021.15
|
| Rate for Payer: UHC Exchange |
$9,087.66
|
| Rate for Payer: UHC Medicare Advantage |
$7,231.78
|
| Rate for Payer: VA VA |
$7,021.15
|
|
|
DERMABOND SKIN ADHESIVE
|
Facility
|
IP
|
$86.16
|
|
|
Service Code
|
NDC 9900-0001-99
|
| Hospital Charge Code |
158456
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.28 |
| Max. Negotiated Rate |
$77.54 |
| Rate for Payer: Aetna Commercial |
$73.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.00
|
| Rate for Payer: Cash Price |
$68.93
|
| Rate for Payer: Cofinity Commercial |
$60.31
|
| Rate for Payer: Cofinity Commercial |
$74.10
|
| Rate for Payer: Healthscope Commercial |
$77.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.24
|
| Rate for Payer: PHP Commercial |
$73.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.31
|
| Rate for Payer: Priority Health SBD |
$54.28
|
|
|
DERMAPLANNING
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 00175
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
IP
|
$430.32
|
|
|
Service Code
|
NDC 50268-220-15
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.10 |
| Max. Negotiated Rate |
$387.29 |
| Rate for Payer: Aetna Commercial |
$365.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.71
|
| Rate for Payer: Cash Price |
$344.26
|
| Rate for Payer: Cofinity Commercial |
$301.22
|
| Rate for Payer: Cofinity Commercial |
$370.08
|
| Rate for Payer: Healthscope Commercial |
$387.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.77
|
| Rate for Payer: PHP Commercial |
$365.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.22
|
| Rate for Payer: Priority Health SBD |
$271.10
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
IP
|
$7.24
|
|
|
Service Code
|
NDC 68084-606-11
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$6.52 |
| Rate for Payer: Aetna Commercial |
$6.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.71
|
| Rate for Payer: Cash Price |
$5.79
|
| Rate for Payer: Cofinity Commercial |
$5.07
|
| Rate for Payer: Cofinity Commercial |
$6.23
|
| Rate for Payer: Healthscope Commercial |
$6.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.15
|
| Rate for Payer: PHP Commercial |
$6.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.07
|
| Rate for Payer: Priority Health SBD |
$4.56
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
IP
|
$8.61
|
|
|
Service Code
|
NDC 50268-220-11
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.60
|
| Rate for Payer: Cash Price |
$6.89
|
| Rate for Payer: Cofinity Commercial |
$6.03
|
| Rate for Payer: Cofinity Commercial |
$7.40
|
| Rate for Payer: Healthscope Commercial |
$7.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.32
|
| Rate for Payer: PHP Commercial |
$7.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.03
|
| Rate for Payer: Priority Health SBD |
$5.42
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
IP
|
$478.08
|
|
|
Service Code
|
NDC 69918-101-01
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$301.19 |
| Max. Negotiated Rate |
$430.27 |
| Rate for Payer: Aetna Commercial |
$406.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.75
|
| Rate for Payer: Cash Price |
$382.46
|
| Rate for Payer: Cofinity Commercial |
$334.66
|
| Rate for Payer: Cofinity Commercial |
$411.15
|
| Rate for Payer: Healthscope Commercial |
$430.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$406.37
|
| Rate for Payer: PHP Commercial |
$406.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.66
|
| Rate for Payer: Priority Health SBD |
$301.19
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
IP
|
$217.01
|
|
|
Service Code
|
NDC 68084-606-21
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.72 |
| Max. Negotiated Rate |
$195.31 |
| Rate for Payer: Aetna Commercial |
$184.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.06
|
| Rate for Payer: Cash Price |
$173.61
|
| Rate for Payer: Cofinity Commercial |
$151.91
|
| Rate for Payer: Cofinity Commercial |
$186.63
|
| Rate for Payer: Healthscope Commercial |
$195.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.46
|
| Rate for Payer: PHP Commercial |
$184.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.91
|
| Rate for Payer: Priority Health SBD |
$136.72
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED)
|
Facility
|
IP
|
$423.69
|
|
|
Service Code
|
NDC 47335-788-91
|
| Hospital Charge Code |
21135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.92 |
| Max. Negotiated Rate |
$381.32 |
| Rate for Payer: Aetna Commercial |
$360.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.40
|
| Rate for Payer: Cash Price |
$338.95
|
| Rate for Payer: Cofinity Commercial |
$296.58
|
| Rate for Payer: Cofinity Commercial |
$364.37
|
| Rate for Payer: Healthscope Commercial |
$381.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$360.14
|
| Rate for Payer: PHP Commercial |
$360.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.58
|
| Rate for Payer: Priority Health SBD |
$266.92
|
|
