|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$218.50
|
|
|
Service Code
|
NDC 00904544861
|
| Hospital Charge Code |
10911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.66 |
| Max. Negotiated Rate |
$196.65 |
| Rate for Payer: Aetna Commercial |
$185.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.03
|
| Rate for Payer: Cash Price |
$174.80
|
| Rate for Payer: Cofinity Advantage |
$152.95
|
| Rate for Payer: Cofinity Commercial |
$187.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.80
|
| Rate for Payer: Healthscope Commercial |
$196.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.88
|
| Rate for Payer: PHP Commercial |
$185.72
|
| Rate for Payer: Priority Health SBD |
$137.66
|
|
|
PEPTAMEN AF BOLUS FEED
|
Facility
|
IP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
150863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.63 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
|
|
PEPTAMEN AF BOLUS FEED
|
Facility
|
OP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
150863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna Medicare |
$31.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: BCBS Complete |
$25.16
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.88
|
| Rate for Payer: UHC Core |
$32.77
|
| Rate for Payer: UHC Exchange |
$24.72
|
|
|
PEPTAMEN AF CONTINUOUS FEED
|
Facility
|
OP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
168955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna Medicare |
$31.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: BCBS Complete |
$25.16
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.88
|
| Rate for Payer: UHC Core |
$32.77
|
| Rate for Payer: UHC Exchange |
$24.72
|
|
|
PEPTAMEN AF CONTINUOUS FEED
|
Facility
|
IP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
168955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.63 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
|
|
PEPTAMEN AF CYCLIC FEED
|
Facility
|
OP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
200079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna Medicare |
$31.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: BCBS Complete |
$25.16
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.88
|
| Rate for Payer: UHC Core |
$32.77
|
| Rate for Payer: UHC Exchange |
$24.72
|
|
|
PEPTAMEN AF CYCLIC FEED
|
Facility
|
IP
|
$62.90
|
|
|
Service Code
|
NDC 98716066380
|
| Hospital Charge Code |
200079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.63 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.88
|
| Rate for Payer: Cash Price |
$50.32
|
| Rate for Payer: Cofinity Advantage |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.32
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.17
|
| Rate for Payer: PHP Commercial |
$53.47
|
| Rate for Payer: Priority Health SBD |
$39.63
|
|
|
PEPTAMEN INTENSE VHP BOLUS FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 43900043271
|
| Hospital Charge Code |
300293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Advantage |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$13.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.80
|
| Rate for Payer: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health SBD |
$9.91
|
|
|
PEPTAMEN INTENSE VHP BOLUS FEED
|
Facility
|
OP
|
$15.73
|
|
|
Service Code
|
NDC 43900043271
|
| Hospital Charge Code |
300293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$7.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: BCBS Complete |
$6.29
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Advantage |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$13.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$14.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.80
|
| Rate for Payer: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health SBD |
$9.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.22
|
| Rate for Payer: UHC Core |
$8.20
|
| Rate for Payer: UHC Exchange |
$6.18
|
|
|
PEPTAMEN INTENSE VHP CONTINUOUS FEED
|
Facility
|
IP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
181406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Advantage |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.73
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health SBD |
$44.29
|
|
|
PEPTAMEN INTENSE VHP CONTINUOUS FEED
|
Facility
|
OP
|
$70.30
|
|
|
Service Code
|
NDC 43900049322
|
| Hospital Charge Code |
181406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna Medicare |
$35.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: BCBS Complete |
$28.12
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Advantage |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.73
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.70
|
| Rate for Payer: UHC Core |
$36.63
|
| Rate for Payer: UHC Exchange |
$27.63
|
|
|
PEPTAMEN INTENSE VHP CONTINUOUS FEED
|
Facility
|
OP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
181406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna Medicare |
$35.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: BCBS Complete |
$28.12
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Advantage |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.73
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.70
|
| Rate for Payer: UHC Core |
$36.63
|
| Rate for Payer: UHC Exchange |
$27.63
|
|
|
PEPTAMEN INTENSE VHP CONTINUOUS FEED
|
Facility
|
IP
|
$70.30
|
|
|
Service Code
|
NDC 43900049322
|
| Hospital Charge Code |
181406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Advantage |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.73
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health SBD |
$44.29
|
|
|
PEPTAMEN INTENSE VHP CYCLIC FEED
|
Facility
|
IP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
300422
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Advantage |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.73
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health SBD |
$44.29
|
|
|
PEPTAMEN INTENSE VHP CYCLIC FEED
|
Facility
|
OP
|
$70.30
|
|
|
Service Code
|
NDC 43900072395
|
| Hospital Charge Code |
300422
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna Medicare |
$35.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: BCBS Complete |
$28.12
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Advantage |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.73
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.70
|
| Rate for Payer: UHC Core |
$36.63
|
| Rate for Payer: UHC Exchange |
$27.63
|
|
|
PEPTAMEN INTENSE VHP CYCLIC FEED
|
Facility
|
OP
|
$15.73
|
|
|
Service Code
|
NDC 43900073049
|
| Hospital Charge Code |
300422
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$7.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: BCBS Complete |
$6.29
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Advantage |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$13.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$14.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.80
|
| Rate for Payer: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health SBD |
$9.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.22
|
| Rate for Payer: UHC Core |
$8.20
|
| Rate for Payer: UHC Exchange |
$6.18
|
|
|
PEPTAMEN INTENSE VHP CYCLIC FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 43900073049
|
| Hospital Charge Code |
300422
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Advantage |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$13.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.80
|
| Rate for Payer: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health SBD |
$9.91
|
|
|
PEPTIC ULCER AND GASTRITIS
|
Facility
|
IP
|
$4,252.74
|
|
|
Service Code
|
APR-DRG 2411
|
| Min. Negotiated Rate |
$4,050.23 |
| Max. Negotiated Rate |
$4,252.74 |
| Rate for Payer: BCBS Complete |
$4,252.74
|
| Rate for Payer: Mclaren Medicaid |
$4,050.23
|
| Rate for Payer: Meridian Medicaid |
$4,252.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,050.23
|
| Rate for Payer: UHC Medicaid |
$4,050.23
|
| Rate for Payer: UHCCP Medicaid |
$4,050.23
|
|
|
PEPTIC ULCER AND GASTRITIS
|
Facility
|
IP
|
$14,433.97
|
|
|
Service Code
|
APR-DRG 2414
|
| Min. Negotiated Rate |
$13,746.64 |
| Max. Negotiated Rate |
$14,433.97 |
| Rate for Payer: BCBS Complete |
$14,433.97
|
| Rate for Payer: Mclaren Medicaid |
$13,746.64
|
| Rate for Payer: Meridian Medicaid |
$14,433.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,746.64
|
| Rate for Payer: UHC Medicaid |
$13,746.64
|
| Rate for Payer: UHCCP Medicaid |
$13,746.64
|
|
|
PEPTIC ULCER AND GASTRITIS
|
Facility
|
IP
|
$5,348.32
|
|
|
Service Code
|
APR-DRG 2412
|
| Min. Negotiated Rate |
$5,093.63 |
| Max. Negotiated Rate |
$5,348.32 |
| Rate for Payer: BCBS Complete |
$5,348.32
|
| Rate for Payer: Mclaren Medicaid |
$5,093.63
|
| Rate for Payer: Meridian Medicaid |
$5,348.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,093.63
|
| Rate for Payer: UHC Medicaid |
$5,093.63
|
| Rate for Payer: UHCCP Medicaid |
$5,093.63
|
|
|
PEPTIC ULCER AND GASTRITIS
|
Facility
|
IP
|
$7,772.80
|
|
|
Service Code
|
APR-DRG 2413
|
| Min. Negotiated Rate |
$7,402.67 |
| Max. Negotiated Rate |
$7,772.80 |
| Rate for Payer: BCBS Complete |
$7,772.80
|
| Rate for Payer: Mclaren Medicaid |
$7,402.67
|
| Rate for Payer: Meridian Medicaid |
$7,772.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,402.67
|
| Rate for Payer: UHC Medicaid |
$7,402.67
|
| Rate for Payer: UHCCP Medicaid |
$7,402.67
|
|
|
PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,035.68
|
|
|
Service Code
|
HCPCS J2547
|
| Hospital Charge Code |
119324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$932.11 |
| Rate for Payer: Aetna Commercial |
$880.33
|
| Rate for Payer: Aetna Medicare |
$1.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.10
|
| Rate for Payer: BCBS Complete |
$0.92
|
| Rate for Payer: BCBS MAPPO |
$1.68
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCN Commercial |
$3.92
|
| Rate for Payer: BCN Medicare Advantage |
$1.68
|
| Rate for Payer: Cash Price |
$828.54
|
| Rate for Payer: Cash Price |
$828.54
|
| Rate for Payer: Cofinity Advantage |
$724.98
|
| Rate for Payer: Cofinity Commercial |
$890.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$828.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.68
|
| Rate for Payer: Healthscope Commercial |
$932.11
|
| Rate for Payer: Mclaren Medicaid |
$0.88
|
| Rate for Payer: Mclaren Medicare |
$1.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.76
|
| Rate for Payer: Meridian Medicaid |
$1.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$880.33
|
| Rate for Payer: Nomi Health Commercial |
$5.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$776.76
|
| Rate for Payer: PACE Medicare |
$1.60
|
| Rate for Payer: PACE SWMI |
$1.68
|
| Rate for Payer: PHP Commercial |
$880.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.31
|
| Rate for Payer: Priority Health Medicare |
$1.68
|
| Rate for Payer: Priority Health SBD |
$652.48
|
| Rate for Payer: Priority Health Tiered Network |
$4.25
|
| Rate for Payer: Railroad Medicare Medicare |
$1.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.77
|
| Rate for Payer: UHC Core |
$2.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.68
|
| Rate for Payer: UHC Exchange |
$2.77
|
| Rate for Payer: UHC Medicaid |
$0.88
|
| Rate for Payer: UHCCP Medicaid |
$0.88
|
| Rate for Payer: VA VA |
$1.68
|
|
|
PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,035.68
|
|
|
Service Code
|
HCPCS J2547
|
| Hospital Charge Code |
119324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$652.48 |
| Max. Negotiated Rate |
$932.11 |
| Rate for Payer: Aetna Commercial |
$880.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.19
|
| Rate for Payer: Cash Price |
$828.54
|
| Rate for Payer: Cofinity Advantage |
$724.98
|
| Rate for Payer: Cofinity Commercial |
$890.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$828.54
|
| Rate for Payer: Healthscope Commercial |
$932.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$880.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$776.76
|
| Rate for Payer: PHP Commercial |
$880.33
|
| Rate for Payer: Priority Health SBD |
$652.48
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC
|
Facility
|
IP
|
$68,964.65
|
|
|
Service Code
|
MSDRG 273
|
| Min. Negotiated Rate |
$30,838.71 |
| Max. Negotiated Rate |
$68,964.65 |
| Rate for Payer: Aetna Medicare |
$33,760.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40,577.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40,577.25
|
| Rate for Payer: BCBS MAPPO |
$32,461.80
|
| Rate for Payer: BCBS Trust/PPO |
$68,964.65
|
| Rate for Payer: BCN Commercial |
$68,964.65
|
| Rate for Payer: BCN Medicare Advantage |
$32,461.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32,461.80
|
| Rate for Payer: Mclaren Medicare |
$32,461.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34,084.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37,331.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$35,707.98
|
| Rate for Payer: Nomi Health Commercial |
$53,218.95
|
| Rate for Payer: PACE Medicare |
$30,838.71
|
| Rate for Payer: PACE SWMI |
$32,461.80
|
| Rate for Payer: PHP Medicare Advantage |
$32,461.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$66,511.89
|
| Rate for Payer: Priority Health Medicare |
$32,461.80
|
| Rate for Payer: Priority Health Tiered Network |
$53,209.50
|
| Rate for Payer: Railroad Medicare Medicare |
$32,461.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67,245.65
|
| Rate for Payer: UHC Core |
$56,259.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32,461.80
|
| Rate for Payer: UHC Exchange |
$45,945.69
|
| Rate for Payer: VA VA |
$32,461.80
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$57,899.69
|
|
|
Service Code
|
MSDRG 274
|
| Min. Negotiated Rate |
$24,717.12 |
| Max. Negotiated Rate |
$57,899.69 |
| Rate for Payer: BCN Commercial |
$57,899.69
|
| Rate for Payer: Aetna Medicare |
$27,058.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32,522.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32,522.53
|
| Rate for Payer: BCBS MAPPO |
$26,018.02
|
| Rate for Payer: BCBS Trust/PPO |
$57,899.69
|
| Rate for Payer: BCN Medicare Advantage |
$26,018.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,018.02
|
| Rate for Payer: Mclaren Medicare |
$26,018.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27,318.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,920.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$28,619.82
|
| Rate for Payer: Nomi Health Commercial |
$42,462.93
|
| Rate for Payer: PACE Medicare |
$24,717.12
|
| Rate for Payer: PACE SWMI |
$26,018.02
|
| Rate for Payer: PHP Medicare Advantage |
$26,018.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$53,069.25
|
| Rate for Payer: Priority Health Medicare |
$26,018.02
|
| Rate for Payer: Priority Health Tiered Network |
$42,455.39
|
| Rate for Payer: Railroad Medicare Medicare |
$26,018.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53,654.71
|
| Rate for Payer: UHC Core |
$44,888.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26,018.02
|
| Rate for Payer: UHC Exchange |
$36,659.66
|
| Rate for Payer: VA VA |
$26,018.02
|
|
