|
MELOXICAM 7.5 MG TABLET
|
Facility
|
OP
|
$160.98
|
|
|
Service Code
|
NDC 50268052515
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.27 |
| Max. Negotiated Rate |
$144.88 |
| Rate for Payer: Aetna Commercial |
$136.83
|
| Rate for Payer: Aetna Medicare |
$80.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.64
|
| Rate for Payer: BCBS Complete |
$64.39
|
| Rate for Payer: Cash Price |
$128.78
|
| Rate for Payer: Cofinity Advantage |
$112.69
|
| Rate for Payer: Cofinity Commercial |
$138.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.78
|
| Rate for Payer: Healthscope Commercial |
$144.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.73
|
| Rate for Payer: PHP Commercial |
$136.83
|
| Rate for Payer: Priority Health SBD |
$101.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.64
|
| Rate for Payer: UHC Core |
$83.87
|
| Rate for Payer: UHC Exchange |
$63.27
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$275.50
|
|
|
Service Code
|
NDC 00904650661
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.27 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna Commercial |
$234.18
|
| Rate for Payer: Aetna Medicare |
$137.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.07
|
| Rate for Payer: BCBS Complete |
$110.20
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cofinity Advantage |
$192.85
|
| Rate for Payer: Cofinity Commercial |
$236.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Healthscope Commercial |
$247.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$220.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.62
|
| Rate for Payer: PHP Commercial |
$234.18
|
| Rate for Payer: Priority Health SBD |
$173.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.07
|
| Rate for Payer: UHC Core |
$143.54
|
| Rate for Payer: UHC Exchange |
$108.27
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$128.31
|
|
|
Service Code
|
NDC 68180023007
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.84 |
| Max. Negotiated Rate |
$115.48 |
| Rate for Payer: Aetna Commercial |
$109.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.40
|
| Rate for Payer: Cash Price |
$102.65
|
| Rate for Payer: Cofinity Advantage |
$89.82
|
| Rate for Payer: Cofinity Commercial |
$110.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.65
|
| Rate for Payer: Healthscope Commercial |
$115.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.23
|
| Rate for Payer: PHP Commercial |
$109.06
|
| Rate for Payer: Priority Health SBD |
$80.84
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
OP
|
$128.31
|
|
|
Service Code
|
NDC 68180023007
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$115.48 |
| Rate for Payer: Aetna Commercial |
$109.06
|
| Rate for Payer: Aetna Medicare |
$64.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.40
|
| Rate for Payer: BCBS Complete |
$51.32
|
| Rate for Payer: Cash Price |
$102.65
|
| Rate for Payer: Cofinity Advantage |
$89.82
|
| Rate for Payer: Cofinity Commercial |
$110.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.65
|
| Rate for Payer: Healthscope Commercial |
$115.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.23
|
| Rate for Payer: PHP Commercial |
$109.06
|
| Rate for Payer: Priority Health SBD |
$80.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.40
|
| Rate for Payer: UHC Core |
$66.85
|
| Rate for Payer: UHC Exchange |
$50.43
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$275.50
|
|
|
Service Code
|
NDC 00904650661
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.56 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna Commercial |
$234.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.07
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cofinity Advantage |
$192.85
|
| Rate for Payer: Cofinity Commercial |
$236.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Healthscope Commercial |
$247.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.62
|
| Rate for Payer: PHP Commercial |
$234.18
|
| Rate for Payer: Priority Health SBD |
$173.56
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
OP
|
$131.10
|
|
|
Service Code
|
NDC 00904650506
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.52 |
| Max. Negotiated Rate |
$117.99 |
| Rate for Payer: Aetna Commercial |
$111.44
|
| Rate for Payer: Aetna Medicare |
$65.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.22
|
| Rate for Payer: BCBS Complete |
$52.44
|
| Rate for Payer: Cash Price |
$104.88
|
| Rate for Payer: Cofinity Advantage |
$91.77
|
| Rate for Payer: Cofinity Commercial |
$112.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.88
|
| Rate for Payer: Healthscope Commercial |
$117.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.33
|
| Rate for Payer: PHP Commercial |
$111.44
|
| Rate for Payer: Priority Health SBD |
$82.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.22
|
| Rate for Payer: UHC Core |
$68.30
|
| Rate for Payer: UHC Exchange |
$51.52
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
IP
|
$131.10
|
|
|
Service Code
|
NDC 00904650506
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.59 |
| Max. Negotiated Rate |
$117.99 |
| Rate for Payer: Aetna Commercial |
$111.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.22
|
| Rate for Payer: Cash Price |
$104.88
|
| Rate for Payer: Cofinity Advantage |
$91.77
|
| Rate for Payer: Cofinity Commercial |
$112.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.88
|
| Rate for Payer: Healthscope Commercial |
$117.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.33
|
| Rate for Payer: PHP Commercial |
$111.44
|
| Rate for Payer: Priority Health SBD |
$82.59
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
IP
|
$247.95
|
|
|
Service Code
|
NDC 00904650561
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.21 |
| Max. Negotiated Rate |
$223.16 |
| Rate for Payer: Aetna Commercial |
$210.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.17
|
| Rate for Payer: Cash Price |
$198.36
|
| Rate for Payer: Cofinity Advantage |
$173.56
|
| Rate for Payer: Cofinity Commercial |
$213.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.36
|
| Rate for Payer: Healthscope Commercial |
$223.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.96
|
| Rate for Payer: PHP Commercial |
$210.76
|
| Rate for Payer: Priority Health SBD |
$156.21
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
IP
|
$368.60
|
|
|
Service Code
|
NDC 00591387044
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.22 |
| Max. Negotiated Rate |
$331.74 |
| Rate for Payer: Aetna Commercial |
$313.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.59
|
| Rate for Payer: Cash Price |
$294.88
|
| Rate for Payer: Cofinity Advantage |
$258.02
|
| Rate for Payer: Cofinity Commercial |
$317.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.88
|
| Rate for Payer: Healthscope Commercial |
$331.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.45
|
| Rate for Payer: PHP Commercial |
$313.31
|
| Rate for Payer: Priority Health SBD |
$232.22
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
OP
|
$368.60
|
|
|
Service Code
|
NDC 00591387044
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.86 |
| Max. Negotiated Rate |
$331.74 |
| Rate for Payer: Aetna Commercial |
$313.31
|
| Rate for Payer: Aetna Medicare |
$184.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.59
|
| Rate for Payer: BCBS Complete |
$147.44
|
| Rate for Payer: Cash Price |
$294.88
|
| Rate for Payer: Cofinity Advantage |
$258.02
|
| Rate for Payer: Cofinity Commercial |
$317.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.88
|
| Rate for Payer: Healthscope Commercial |
$331.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$294.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.45
|
| Rate for Payer: PHP Commercial |
$313.31
|
| Rate for Payer: Priority Health SBD |
$232.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.59
|
| Rate for Payer: UHC Core |
$192.04
|
| Rate for Payer: UHC Exchange |
$144.86
|
|
|
MEMANTINE 5 MG TABLET
|
Facility
|
OP
|
$247.95
|
|
|
Service Code
|
NDC 00904650561
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$223.16 |
| Rate for Payer: Aetna Commercial |
$210.76
|
| Rate for Payer: Aetna Medicare |
$123.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.17
|
| Rate for Payer: BCBS Complete |
$99.18
|
| Rate for Payer: Cash Price |
$198.36
|
| Rate for Payer: Cofinity Advantage |
$173.56
|
| Rate for Payer: Cofinity Commercial |
$213.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.36
|
| Rate for Payer: Healthscope Commercial |
$223.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.96
|
| Rate for Payer: PHP Commercial |
$210.76
|
| Rate for Payer: Priority Health SBD |
$156.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.17
|
| Rate for Payer: UHC Core |
$129.18
|
| Rate for Payer: UHC Exchange |
$97.44
|
|
|
MENINGOCOCCAL B VAC,4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE
|
Facility
|
OP
|
$579.14
|
|
|
Service Code
|
HCPCS 90620
|
| Hospital Charge Code |
173649
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$216.14 |
| Max. Negotiated Rate |
$583.91 |
| Rate for Payer: Aetna Commercial |
$492.27
|
| Rate for Payer: Aetna Medicare |
$289.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.44
|
| Rate for Payer: BCBS Complete |
$231.66
|
| Rate for Payer: BCBS Trust/PPO |
$583.91
|
| Rate for Payer: BCN Commercial |
$583.91
|
| Rate for Payer: Cash Price |
$463.31
|
| Rate for Payer: Cash Price |
$463.31
|
| Rate for Payer: Cofinity Advantage |
$405.40
|
| Rate for Payer: Cofinity Commercial |
$498.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.31
|
| Rate for Payer: Healthscope Commercial |
$521.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$463.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$434.36
|
| Rate for Payer: PHP Commercial |
$492.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$270.18
|
| Rate for Payer: Priority Health SBD |
$364.86
|
| Rate for Payer: Priority Health Tiered Network |
$216.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$497.34
|
| Rate for Payer: UHC Core |
$497.34
|
| Rate for Payer: UHC Exchange |
$497.34
|
|
|
MENINGOCOCCAL B VAC,4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE
|
Facility
|
IP
|
$579.14
|
|
|
Service Code
|
HCPCS 90620
|
| Hospital Charge Code |
173649
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$364.86 |
| Max. Negotiated Rate |
$521.23 |
| Rate for Payer: Aetna Commercial |
$492.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.44
|
| Rate for Payer: Cash Price |
$463.31
|
| Rate for Payer: Cofinity Advantage |
$405.40
|
| Rate for Payer: Cofinity Commercial |
$498.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.31
|
| Rate for Payer: Healthscope Commercial |
$521.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$434.36
|
| Rate for Payer: PHP Commercial |
$492.27
|
| Rate for Payer: Priority Health SBD |
$364.86
|
|
|
MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION
|
Facility
|
IP
|
$401.05
|
|
|
Service Code
|
HCPCS 90619
|
| Hospital Charge Code |
194943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$252.66 |
| Max. Negotiated Rate |
$360.94 |
| Rate for Payer: Aetna Commercial |
$340.89
|
| Rate for Payer: Aetna Commercial |
$323.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.23
|
| Rate for Payer: Cash Price |
$320.84
|
| Rate for Payer: Cash Price |
$304.29
|
| Rate for Payer: Cofinity Advantage |
$266.25
|
| Rate for Payer: Cofinity Advantage |
$280.74
|
| Rate for Payer: Cofinity Commercial |
$327.11
|
| Rate for Payer: Cofinity Commercial |
$344.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.29
|
| Rate for Payer: Healthscope Commercial |
$360.94
|
| Rate for Payer: Healthscope Commercial |
$342.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.79
|
| Rate for Payer: PHP Commercial |
$340.89
|
| Rate for Payer: PHP Commercial |
$323.31
|
| Rate for Payer: Priority Health SBD |
$252.66
|
| Rate for Payer: Priority Health SBD |
$239.63
|
|
|
MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION
|
Facility
|
OP
|
$401.05
|
|
|
Service Code
|
HCPCS 90619
|
| Hospital Charge Code |
194943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.42 |
| Max. Negotiated Rate |
$436.12 |
| Rate for Payer: Aetna Commercial |
$340.89
|
| Rate for Payer: Aetna Commercial |
$323.31
|
| Rate for Payer: Aetna Medicare |
$190.18
|
| Rate for Payer: Aetna Medicare |
$200.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.68
|
| Rate for Payer: BCBS Complete |
$152.14
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS Trust/PPO |
$436.12
|
| Rate for Payer: BCBS Trust/PPO |
$436.12
|
| Rate for Payer: BCN Commercial |
$436.12
|
| Rate for Payer: BCN Commercial |
$436.12
|
| Rate for Payer: Cash Price |
$304.29
|
| Rate for Payer: Cash Price |
$304.29
|
| Rate for Payer: Cash Price |
$320.84
|
| Rate for Payer: Cash Price |
$320.84
|
| Rate for Payer: Cofinity Advantage |
$266.25
|
| Rate for Payer: Cofinity Advantage |
$280.74
|
| Rate for Payer: Cofinity Commercial |
$327.11
|
| Rate for Payer: Cofinity Commercial |
$344.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.84
|
| Rate for Payer: Healthscope Commercial |
$342.32
|
| Rate for Payer: Healthscope Commercial |
$360.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$304.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.79
|
| Rate for Payer: PHP Commercial |
$323.31
|
| Rate for Payer: PHP Commercial |
$340.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$201.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$201.76
|
| Rate for Payer: Priority Health SBD |
$252.66
|
| Rate for Payer: Priority Health SBD |
$239.63
|
| Rate for Payer: Priority Health Tiered Network |
$161.41
|
| Rate for Payer: Priority Health Tiered Network |
$161.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.43
|
| Rate for Payer: UHC Core |
$350.43
|
| Rate for Payer: UHC Core |
$350.43
|
| Rate for Payer: UHC Exchange |
$350.43
|
| Rate for Payer: UHC Exchange |
$350.43
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
|
Facility
|
IP
|
$2,313.84
|
|
|
Service Code
|
APR-DRG 5321
|
| Min. Negotiated Rate |
$2,203.66 |
| Max. Negotiated Rate |
$2,313.84 |
| Rate for Payer: BCBS Complete |
$2,313.84
|
| Rate for Payer: Mclaren Medicaid |
$2,203.66
|
| Rate for Payer: Meridian Medicaid |
$2,313.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,203.66
|
| Rate for Payer: UHC Medicaid |
$2,203.66
|
| Rate for Payer: UHCCP Medicaid |
$2,203.66
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
|
Facility
|
IP
|
$6,556.26
|
|
|
Service Code
|
APR-DRG 5323
|
| Min. Negotiated Rate |
$6,244.06 |
| Max. Negotiated Rate |
$6,556.26 |
| Rate for Payer: BCBS Complete |
$6,556.26
|
| Rate for Payer: Mclaren Medicaid |
$6,244.06
|
| Rate for Payer: Meridian Medicaid |
$6,556.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,244.06
|
| Rate for Payer: UHC Medicaid |
$6,244.06
|
| Rate for Payer: UHCCP Medicaid |
$6,244.06
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
|
Facility
|
IP
|
$12,257.73
|
|
|
Service Code
|
APR-DRG 5324
|
| Min. Negotiated Rate |
$11,674.03 |
| Max. Negotiated Rate |
$12,257.73 |
| Rate for Payer: BCBS Complete |
$12,257.73
|
| Rate for Payer: Mclaren Medicaid |
$11,674.03
|
| Rate for Payer: Meridian Medicaid |
$12,257.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,674.03
|
| Rate for Payer: UHC Medicaid |
$11,674.03
|
| Rate for Payer: UHCCP Medicaid |
$11,674.03
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
|
Facility
|
IP
|
$3,192.13
|
|
|
Service Code
|
APR-DRG 5322
|
| Min. Negotiated Rate |
$3,040.13 |
| Max. Negotiated Rate |
$3,192.13 |
| Rate for Payer: BCBS Complete |
$3,192.13
|
| Rate for Payer: Mclaren Medicaid |
$3,040.13
|
| Rate for Payer: Meridian Medicaid |
$3,192.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,040.13
|
| Rate for Payer: UHC Medicaid |
$3,040.13
|
| Rate for Payer: UHCCP Medicaid |
$3,040.13
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$16,422.25
|
|
|
Service Code
|
MSDRG 760
|
| Min. Negotiated Rate |
$7,946.93 |
| Max. Negotiated Rate |
$16,422.25 |
| Rate for Payer: Aetna Medicare |
$8,699.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,456.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,456.49
|
| Rate for Payer: BCBS MAPPO |
$8,365.19
|
| Rate for Payer: BCBS Trust/PPO |
$15,938.51
|
| Rate for Payer: BCN Commercial |
$15,938.51
|
| Rate for Payer: BCN Medicare Advantage |
$8,365.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,365.19
|
| Rate for Payer: Mclaren Medicare |
$8,365.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,783.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,619.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,201.71
|
| Rate for Payer: Nomi Health Commercial |
$12,996.75
|
| Rate for Payer: PACE Medicare |
$7,946.93
|
| Rate for Payer: PACE SWMI |
$8,365.19
|
| Rate for Payer: PHP Medicare Advantage |
$8,365.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,243.06
|
| Rate for Payer: Priority Health Medicare |
$8,365.19
|
| Rate for Payer: Priority Health Tiered Network |
$12,994.44
|
| Rate for Payer: Railroad Medicare Medicare |
$8,365.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,422.25
|
| Rate for Payer: UHC Core |
$13,739.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,365.19
|
| Rate for Payer: UHC Exchange |
$11,220.53
|
| Rate for Payer: VA VA |
$8,365.19
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,697.93
|
|
|
Service Code
|
MSDRG 761
|
| Min. Negotiated Rate |
$4,738.56 |
| Max. Negotiated Rate |
$9,697.93 |
| Rate for Payer: Aetna Medicare |
$5,187.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,234.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,234.95
|
| Rate for Payer: BCBS MAPPO |
$4,987.96
|
| Rate for Payer: BCBS Trust/PPO |
$9,697.93
|
| Rate for Payer: BCN Commercial |
$9,697.93
|
| Rate for Payer: BCN Medicare Advantage |
$4,987.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,987.96
|
| Rate for Payer: Mclaren Medicare |
$4,987.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,237.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,736.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,486.76
|
| Rate for Payer: Nomi Health Commercial |
$7,347.84
|
| Rate for Payer: PACE Medicare |
$4,738.56
|
| Rate for Payer: PACE SWMI |
$4,987.96
|
| Rate for Payer: PHP Medicare Advantage |
$4,987.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,197.68
|
| Rate for Payer: Priority Health Medicare |
$4,987.96
|
| Rate for Payer: Priority Health Tiered Network |
$7,358.14
|
| Rate for Payer: Railroad Medicare Medicare |
$4,987.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,284.48
|
| Rate for Payer: UHC Core |
$7,767.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,987.96
|
| Rate for Payer: UHC Exchange |
$6,343.64
|
| Rate for Payer: VA VA |
$4,987.96
|
|
|
MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$5,687.71
|
|
|
Service Code
|
APR-DRG 7401
|
| Min. Negotiated Rate |
$5,416.87 |
| Max. Negotiated Rate |
$5,687.71 |
| Rate for Payer: BCBS Complete |
$5,687.71
|
| Rate for Payer: Mclaren Medicaid |
$5,416.87
|
| Rate for Payer: Meridian Medicaid |
$5,687.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,416.87
|
| Rate for Payer: UHC Medicaid |
$5,416.87
|
| Rate for Payer: UHCCP Medicaid |
$5,416.87
|
|
|
MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$17,720.70
|
|
|
Service Code
|
APR-DRG 7403
|
| Min. Negotiated Rate |
$16,876.86 |
| Max. Negotiated Rate |
$17,720.70 |
| Rate for Payer: BCBS Complete |
$17,720.70
|
| Rate for Payer: Mclaren Medicaid |
$16,876.86
|
| Rate for Payer: Meridian Medicaid |
$17,720.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,876.86
|
| Rate for Payer: UHC Medicaid |
$16,876.86
|
| Rate for Payer: UHCCP Medicaid |
$16,876.86
|
|
|
MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$33,180.31
|
|
|
Service Code
|
APR-DRG 7404
|
| Min. Negotiated Rate |
$31,600.30 |
| Max. Negotiated Rate |
$33,180.31 |
| Rate for Payer: BCBS Complete |
$33,180.31
|
| Rate for Payer: Mclaren Medicaid |
$31,600.30
|
| Rate for Payer: Meridian Medicaid |
$33,180.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$31,600.30
|
| Rate for Payer: UHC Medicaid |
$31,600.30
|
| Rate for Payer: UHCCP Medicaid |
$31,600.30
|
|
|
MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$9,561.50
|
|
|
Service Code
|
APR-DRG 7402
|
| Min. Negotiated Rate |
$9,106.19 |
| Max. Negotiated Rate |
$9,561.50 |
| Rate for Payer: BCBS Complete |
$9,561.50
|
| Rate for Payer: Mclaren Medicaid |
$9,106.19
|
| Rate for Payer: Meridian Medicaid |
$9,561.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,106.19
|
| Rate for Payer: UHC Medicaid |
$9,106.19
|
| Rate for Payer: UHCCP Medicaid |
$9,106.19
|
|
