RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$582.09
|
|
Service Code
|
NDC 60687-266-21
|
Hospital Charge Code |
22143
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$366.72 |
Max. Negotiated Rate |
$523.88 |
Rate for Payer: Aetna Commercial |
$494.78
|
Rate for Payer: Aetna New Business (MI Preferred) |
$378.36
|
Rate for Payer: Cash Price |
$465.67
|
Rate for Payer: Cofinity Commercial |
$407.46
|
Rate for Payer: Cofinity Commercial |
$500.60
|
Rate for Payer: Healthscope Commercial |
$523.88
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$494.78
|
Rate for Payer: PHP Commercial |
$494.78
|
Rate for Payer: Priority Health Cigna Priority Health |
$407.46
|
Rate for Payer: Priority Health SBD |
$366.72
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$87.12
|
|
Service Code
|
NDC 65162-057-03
|
Hospital Charge Code |
22143
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$54.89 |
Max. Negotiated Rate |
$78.41 |
Rate for Payer: Aetna Commercial |
$74.05
|
Rate for Payer: Aetna New Business (MI Preferred) |
$56.63
|
Rate for Payer: Cash Price |
$69.70
|
Rate for Payer: Cofinity Commercial |
$60.98
|
Rate for Payer: Cofinity Commercial |
$74.92
|
Rate for Payer: Healthscope Commercial |
$78.41
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.05
|
Rate for Payer: PHP Commercial |
$74.05
|
Rate for Payer: Priority Health Cigna Priority Health |
$60.98
|
Rate for Payer: Priority Health SBD |
$54.89
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$681.32
|
|
Service Code
|
NDC 0002-4184-30
|
Hospital Charge Code |
22143
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$429.23 |
Max. Negotiated Rate |
$613.19 |
Rate for Payer: Aetna Commercial |
$579.12
|
Rate for Payer: Aetna New Business (MI Preferred) |
$442.86
|
Rate for Payer: Cash Price |
$545.06
|
Rate for Payer: Cofinity Commercial |
$476.92
|
Rate for Payer: Cofinity Commercial |
$585.94
|
Rate for Payer: Healthscope Commercial |
$613.19
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$579.12
|
Rate for Payer: PHP Commercial |
$579.12
|
Rate for Payer: Priority Health Cigna Priority Health |
$476.92
|
Rate for Payer: Priority Health SBD |
$429.23
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$9.67
|
|
Service Code
|
NDC 50268-694-11
|
Hospital Charge Code |
22143
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$6.09 |
Max. Negotiated Rate |
$8.70 |
Rate for Payer: Aetna Commercial |
$8.22
|
Rate for Payer: Aetna New Business (MI Preferred) |
$6.29
|
Rate for Payer: Cash Price |
$7.74
|
Rate for Payer: Cofinity Commercial |
$6.77
|
Rate for Payer: Cofinity Commercial |
$8.32
|
Rate for Payer: Healthscope Commercial |
$8.70
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.22
|
Rate for Payer: PHP Commercial |
$8.22
|
Rate for Payer: Priority Health Cigna Priority Health |
$6.77
|
Rate for Payer: Priority Health SBD |
$6.09
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$483.22
|
|
Service Code
|
NDC 50268-694-15
|
Hospital Charge Code |
22143
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$304.43 |
Max. Negotiated Rate |
$434.90 |
Rate for Payer: Aetna Commercial |
$410.74
|
Rate for Payer: Aetna New Business (MI Preferred) |
$314.09
|
Rate for Payer: Cash Price |
$386.58
|
Rate for Payer: Cofinity Commercial |
$338.25
|
Rate for Payer: Cofinity Commercial |
$415.57
|
Rate for Payer: Healthscope Commercial |
$434.90
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$410.74
|
Rate for Payer: PHP Commercial |
$410.74
|
Rate for Payer: Priority Health Cigna Priority Health |
$338.25
|
Rate for Payer: Priority Health SBD |
$304.43
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
IP
|
$7,203.46
|
|
Service Code
|
NDC 0006-0227-61
|
Hospital Charge Code |
88608
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$4,538.18 |
Max. Negotiated Rate |
$6,483.11 |
Rate for Payer: Aetna Commercial |
$6,122.94
|
Rate for Payer: Aetna New Business (MI Preferred) |
$4,682.25
|
Rate for Payer: Cash Price |
$5,762.77
|
Rate for Payer: Cofinity Commercial |
$5,042.42
|
Rate for Payer: Cofinity Commercial |
$6,194.98
|
Rate for Payer: Healthscope Commercial |
$6,483.11
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,122.94
|
Rate for Payer: PHP Commercial |
$6,122.94
|
Rate for Payer: Priority Health Cigna Priority Health |
$5,042.42
|
Rate for Payer: Priority Health SBD |
$4,538.18
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
IP
|
$173.90
|
|
Service Code
|
NDC 65862-474-01
|
Hospital Charge Code |
11258
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$109.56 |
Max. Negotiated Rate |
$156.51 |
Rate for Payer: Aetna Commercial |
$147.82
|
Rate for Payer: Aetna New Business (MI Preferred) |
$113.04
|
Rate for Payer: Cash Price |
$139.12
|
Rate for Payer: Cofinity Commercial |
$149.55
|
Rate for Payer: Cofinity Commercial |
$121.73
|
Rate for Payer: Healthscope Commercial |
$156.51
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.82
|
Rate for Payer: PHP Commercial |
$147.82
|
Rate for Payer: Priority Health Cigna Priority Health |
$121.73
|
Rate for Payer: Priority Health SBD |
$109.56
|
|
RAMIPRIL 5 MG CAPSULE
|
Facility
|
IP
|
$105.75
|
|
Service Code
|
NDC 65862-476-01
|
Hospital Charge Code |
11261
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$66.62 |
Max. Negotiated Rate |
$95.18 |
Rate for Payer: Aetna Commercial |
$89.89
|
Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
Rate for Payer: Cash Price |
$84.60
|
Rate for Payer: Cofinity Commercial |
$74.02
|
Rate for Payer: Cofinity Commercial |
$90.94
|
Rate for Payer: Healthscope Commercial |
$95.18
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.89
|
Rate for Payer: PHP Commercial |
$89.89
|
Rate for Payer: Priority Health Cigna Priority Health |
$74.02
|
Rate for Payer: Priority Health SBD |
$66.62
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$32,063.77
|
|
Service Code
|
HCPCS J9308
|
Hospital Charge Code |
170507
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$20,200.18 |
Max. Negotiated Rate |
$28,857.39 |
Rate for Payer: Aetna Commercial |
$27,254.20
|
Rate for Payer: Aetna Commercial |
$5,450.85
|
Rate for Payer: Aetna New Business (MI Preferred) |
$20,841.45
|
Rate for Payer: Aetna New Business (MI Preferred) |
$4,168.29
|
Rate for Payer: Cash Price |
$25,651.02
|
Rate for Payer: Cash Price |
$5,130.21
|
Rate for Payer: Cofinity Commercial |
$27,574.84
|
Rate for Payer: Cofinity Commercial |
$5,514.97
|
Rate for Payer: Cofinity Commercial |
$4,488.93
|
Rate for Payer: Cofinity Commercial |
$22,444.64
|
Rate for Payer: Healthscope Commercial |
$5,771.48
|
Rate for Payer: Healthscope Commercial |
$28,857.39
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27,254.20
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,450.85
|
Rate for Payer: PHP Commercial |
$27,254.20
|
Rate for Payer: PHP Commercial |
$5,450.85
|
Rate for Payer: Priority Health Cigna Priority Health |
$4,488.93
|
Rate for Payer: Priority Health Cigna Priority Health |
$22,444.64
|
Rate for Payer: Priority Health SBD |
$20,200.18
|
Rate for Payer: Priority Health SBD |
$4,040.04
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$32,063.77
|
|
Service Code
|
HCPCS J9308
|
Hospital Charge Code |
170507
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$38.42 |
Max. Negotiated Rate |
$28,857.39 |
Rate for Payer: Aetna Commercial |
$27,254.20
|
Rate for Payer: Aetna Commercial |
$5,450.85
|
Rate for Payer: Aetna Medicare |
$73.05
|
Rate for Payer: Aetna Medicare |
$73.05
|
Rate for Payer: Aetna New Business (MI Preferred) |
$4,168.29
|
Rate for Payer: Aetna New Business (MI Preferred) |
$20,841.45
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.80
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.80
|
Rate for Payer: Amish Plain Church Group Commercial |
$87.80
|
Rate for Payer: Amish Plain Church Group Commercial |
$87.80
|
Rate for Payer: BCBS Complete |
$40.35
|
Rate for Payer: BCBS Complete |
$40.35
|
Rate for Payer: BCBS MAPPO |
$70.24
|
Rate for Payer: BCBS MAPPO |
$70.24
|
Rate for Payer: BCBS Trust/PPO |
$207.93
|
Rate for Payer: BCBS Trust/PPO |
$207.93
|
Rate for Payer: BCN Medicare Advantage |
$70.24
|
Rate for Payer: BCN Medicare Advantage |
$70.24
|
Rate for Payer: Cash Price |
$25,651.02
|
Rate for Payer: Cash Price |
$5,130.21
|
Rate for Payer: Cash Price |
$25,651.02
|
Rate for Payer: Cash Price |
$5,130.21
|
Rate for Payer: Cofinity Commercial |
$27,574.84
|
Rate for Payer: Cofinity Commercial |
$4,488.93
|
Rate for Payer: Cofinity Commercial |
$5,514.97
|
Rate for Payer: Cofinity Commercial |
$22,444.64
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.24
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.24
|
Rate for Payer: Healthscope Commercial |
$28,857.39
|
Rate for Payer: Healthscope Commercial |
$5,771.48
|
Rate for Payer: Mclaren Medicaid |
$38.42
|
Rate for Payer: Mclaren Medicaid |
$38.42
|
Rate for Payer: Mclaren Medicare |
$70.24
|
Rate for Payer: Mclaren Medicare |
$70.24
|
Rate for Payer: Meridian Medicaid |
$40.35
|
Rate for Payer: Meridian Medicaid |
$40.35
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.76
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.76
|
Rate for Payer: MI Amish Medical Board Commercial |
$80.78
|
Rate for Payer: MI Amish Medical Board Commercial |
$80.78
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,450.85
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27,254.20
|
Rate for Payer: PACE Medicare |
$66.73
|
Rate for Payer: PACE Medicare |
$66.73
|
Rate for Payer: PACE SWMI |
$70.24
|
Rate for Payer: PACE SWMI |
$70.24
|
Rate for Payer: PHP Commercial |
$5,450.85
|
Rate for Payer: PHP Commercial |
$27,254.20
|
Rate for Payer: PHP Medicare Advantage |
$70.24
|
Rate for Payer: PHP Medicare Advantage |
$70.24
|
Rate for Payer: Priority Health Choice Medicaid |
$38.42
|
Rate for Payer: Priority Health Choice Medicaid |
$38.42
|
Rate for Payer: Priority Health Cigna Priority Health |
$22,444.64
|
Rate for Payer: Priority Health Cigna Priority Health |
$4,488.93
|
Rate for Payer: Priority Health Medicare |
$70.24
|
Rate for Payer: Priority Health Medicare |
$70.24
|
Rate for Payer: Priority Health SBD |
$20,200.18
|
Rate for Payer: Priority Health SBD |
$4,040.04
|
Rate for Payer: Railroad Medicare Medicare |
$70.24
|
Rate for Payer: Railroad Medicare Medicare |
$70.24
|
Rate for Payer: UHC Dual Complete DSNP |
$70.24
|
Rate for Payer: UHC Dual Complete DSNP |
$70.24
|
Rate for Payer: UHC Medicare Advantage |
$72.35
|
Rate for Payer: UHC Medicare Advantage |
$72.35
|
Rate for Payer: VA VA |
$70.24
|
Rate for Payer: VA VA |
$70.24
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$1,414.81
|
|
Service Code
|
NDC 61958-1003-1
|
Hospital Charge Code |
70434
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$891.33 |
Max. Negotiated Rate |
$1,273.33 |
Rate for Payer: Aetna Commercial |
$1,202.59
|
Rate for Payer: Aetna New Business (MI Preferred) |
$919.63
|
Rate for Payer: Cash Price |
$1,131.85
|
Rate for Payer: Cofinity Commercial |
$1,216.74
|
Rate for Payer: Cofinity Commercial |
$990.37
|
Rate for Payer: Healthscope Commercial |
$1,273.33
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,202.59
|
Rate for Payer: PHP Commercial |
$1,202.59
|
Rate for Payer: Priority Health Cigna Priority Health |
$990.37
|
Rate for Payer: Priority Health SBD |
$891.33
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$381.03
|
|
Service Code
|
NDC 45963-418-06
|
Hospital Charge Code |
70434
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$240.05 |
Max. Negotiated Rate |
$342.93 |
Rate for Payer: Aetna Commercial |
$323.88
|
Rate for Payer: Aetna New Business (MI Preferred) |
$247.67
|
Rate for Payer: Cash Price |
$304.82
|
Rate for Payer: Cofinity Commercial |
$266.72
|
Rate for Payer: Cofinity Commercial |
$327.69
|
Rate for Payer: Healthscope Commercial |
$342.93
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.88
|
Rate for Payer: PHP Commercial |
$323.88
|
Rate for Payer: Priority Health Cigna Priority Health |
$266.72
|
Rate for Payer: Priority Health SBD |
$240.05
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$5.78
|
|
Service Code
|
NDC 60687-549-11
|
Hospital Charge Code |
70434
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$3.64 |
Max. Negotiated Rate |
$5.20 |
Rate for Payer: Aetna Commercial |
$4.91
|
Rate for Payer: Aetna New Business (MI Preferred) |
$3.76
|
Rate for Payer: Cash Price |
$4.62
|
Rate for Payer: Cofinity Commercial |
$4.05
|
Rate for Payer: Cofinity Commercial |
$4.97
|
Rate for Payer: Healthscope Commercial |
$5.20
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.91
|
Rate for Payer: PHP Commercial |
$4.91
|
Rate for Payer: Priority Health Cigna Priority Health |
$4.05
|
Rate for Payer: Priority Health SBD |
$3.64
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$173.38
|
|
Service Code
|
NDC 60687-549-21
|
Hospital Charge Code |
70434
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$109.23 |
Max. Negotiated Rate |
$156.04 |
Rate for Payer: Aetna Commercial |
$147.37
|
Rate for Payer: Aetna New Business (MI Preferred) |
$112.70
|
Rate for Payer: Cash Price |
$138.70
|
Rate for Payer: Cofinity Commercial |
$121.37
|
Rate for Payer: Cofinity Commercial |
$149.11
|
Rate for Payer: Healthscope Commercial |
$156.04
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.37
|
Rate for Payer: PHP Commercial |
$147.37
|
Rate for Payer: Priority Health Cigna Priority Health |
$121.37
|
Rate for Payer: Priority Health SBD |
$109.23
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
IP
|
$335.56
|
|
Service Code
|
NDC 67877-259-30
|
Hospital Charge Code |
76480
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$211.40 |
Max. Negotiated Rate |
$302.00 |
Rate for Payer: Aetna Commercial |
$285.23
|
Rate for Payer: Aetna New Business (MI Preferred) |
$218.11
|
Rate for Payer: Cash Price |
$268.45
|
Rate for Payer: Cofinity Commercial |
$234.89
|
Rate for Payer: Cofinity Commercial |
$288.58
|
Rate for Payer: Healthscope Commercial |
$302.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$285.23
|
Rate for Payer: PHP Commercial |
$285.23
|
Rate for Payer: Priority Health Cigna Priority Health |
$234.89
|
Rate for Payer: Priority Health SBD |
$211.40
|
|
RASAGILINE 1 MG TABLET
|
Facility
|
IP
|
$3,935.18
|
|
Service Code
|
NDC 68546-229-56
|
Hospital Charge Code |
76481
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$2,479.16 |
Max. Negotiated Rate |
$3,541.66 |
Rate for Payer: Aetna Commercial |
$3,344.90
|
Rate for Payer: Aetna New Business (MI Preferred) |
$2,557.87
|
Rate for Payer: Cash Price |
$3,148.14
|
Rate for Payer: Cofinity Commercial |
$2,754.63
|
Rate for Payer: Cofinity Commercial |
$3,384.25
|
Rate for Payer: Healthscope Commercial |
$3,541.66
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,344.90
|
Rate for Payer: PHP Commercial |
$3,344.90
|
Rate for Payer: Priority Health Cigna Priority Health |
$2,754.63
|
Rate for Payer: Priority Health SBD |
$2,479.16
|
|
RASAGILINE 1 MG TABLET
|
Facility
|
IP
|
$737.04
|
|
Service Code
|
NDC 0093-3061-56
|
Hospital Charge Code |
76481
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$464.34 |
Max. Negotiated Rate |
$663.34 |
Rate for Payer: Aetna Commercial |
$626.48
|
Rate for Payer: Aetna New Business (MI Preferred) |
$479.08
|
Rate for Payer: Cash Price |
$589.63
|
Rate for Payer: Cofinity Commercial |
$515.93
|
Rate for Payer: Cofinity Commercial |
$633.85
|
Rate for Payer: Healthscope Commercial |
$663.34
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$626.48
|
Rate for Payer: PHP Commercial |
$626.48
|
Rate for Payer: Priority Health Cigna Priority Health |
$515.93
|
Rate for Payer: Priority Health SBD |
$464.34
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,438.46
|
|
Service Code
|
HCPCS J2783
|
Hospital Charge Code |
33591
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$2,166.23 |
Max. Negotiated Rate |
$3,094.61 |
Rate for Payer: Aetna Commercial |
$2,922.69
|
Rate for Payer: Aetna New Business (MI Preferred) |
$2,235.00
|
Rate for Payer: Cash Price |
$2,750.77
|
Rate for Payer: Cofinity Commercial |
$2,406.92
|
Rate for Payer: Cofinity Commercial |
$2,957.08
|
Rate for Payer: Healthscope Commercial |
$3,094.61
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,922.69
|
Rate for Payer: PHP Commercial |
$2,922.69
|
Rate for Payer: Priority Health Cigna Priority Health |
$2,406.92
|
Rate for Payer: Priority Health SBD |
$2,166.23
|
|
RASBURICASE 7.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$13,968.69
|
|
Service Code
|
HCPCS J2783
|
Hospital Charge Code |
76868
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$8,800.27 |
Max. Negotiated Rate |
$12,571.82 |
Rate for Payer: Aetna Commercial |
$11,873.39
|
Rate for Payer: Aetna New Business (MI Preferred) |
$9,079.65
|
Rate for Payer: Cash Price |
$11,174.95
|
Rate for Payer: Cofinity Commercial |
$12,013.07
|
Rate for Payer: Cofinity Commercial |
$9,778.08
|
Rate for Payer: Healthscope Commercial |
$12,571.82
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,873.39
|
Rate for Payer: PHP Commercial |
$11,873.39
|
Rate for Payer: Priority Health Cigna Priority Health |
$9,778.08
|
Rate for Payer: Priority Health SBD |
$8,800.27
|
|
RECONSTRUCTION (ADVANCEMENT), POSTERIOR TIBIAL TENDON WITH EXCISION OF ACCESSORY TARSAL NAVICULAR BONE (EG, KIDNER TYPE PROCEDURE)
|
Facility
|
OP
|
$7,957.04
|
|
Service Code
|
CPT 28238
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$484.29 |
Max. Negotiated Rate |
$7,957.04 |
Rate for Payer: Aetna Medicare |
$6,620.26
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,957.04
|
Rate for Payer: Amish Plain Church Group Commercial |
$7,957.04
|
Rate for Payer: BCBS Complete |
$3,656.42
|
Rate for Payer: BCBS MAPPO |
$6,365.63
|
Rate for Payer: BCBS Trust/PPO |
$2,451.57
|
Rate for Payer: BCN Medicare Advantage |
$6,365.63
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,365.63
|
Rate for Payer: Mclaren Medicaid |
$3,482.00
|
Rate for Payer: Mclaren Medicare |
$6,365.63
|
Rate for Payer: Meridian Medicaid |
$3,656.42
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,683.91
|
Rate for Payer: MI Amish Medical Board Commercial |
$7,320.47
|
Rate for Payer: PACE Medicare |
$6,047.35
|
Rate for Payer: PACE SWMI |
$6,365.63
|
Rate for Payer: PHP Medicare Advantage |
$6,365.63
|
Rate for Payer: Priority Health Choice Medicaid |
$3,482.00
|
Rate for Payer: Priority Health Medicare |
$6,365.63
|
Rate for Payer: Railroad Medicare Medicare |
$6,365.63
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$532.72
|
Rate for Payer: UHC Core |
$7,632.00
|
Rate for Payer: UHC Dual Complete DSNP |
$6,365.63
|
Rate for Payer: UHC Exchange |
$484.29
|
Rate for Payer: UHC Medicare Advantage |
$6,556.60
|
Rate for Payer: VA VA |
$6,365.63
|
|
RECONSTRUCTION, ANGULAR DEFORMITY OF TOE, SOFT TISSUE PROCEDURES ONLY (EG, OVERLAPPING SECOND TOE, FIFTH TOE, CURLY TOES)
|
Facility
|
OP
|
$4,155.00
|
|
Service Code
|
CPT 28313
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$359.53 |
Max. Negotiated Rate |
$4,155.00 |
Rate for Payer: Aetna Medicare |
$2,995.31
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
Rate for Payer: BCBS Complete |
$1,654.34
|
Rate for Payer: BCBS MAPPO |
$2,880.11
|
Rate for Payer: BCBS Trust/PPO |
$1,058.03
|
Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
Rate for Payer: Mclaren Medicaid |
$1,575.42
|
Rate for Payer: Mclaren Medicare |
$2,880.11
|
Rate for Payer: Meridian Medicaid |
$1,654.34
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
Rate for Payer: PACE Medicare |
$2,736.10
|
Rate for Payer: PACE SWMI |
$2,880.11
|
Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
Rate for Payer: Priority Health Medicare |
$2,880.11
|
Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$395.48
|
Rate for Payer: UHC Core |
$4,155.00
|
Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
Rate for Payer: UHC Exchange |
$359.53
|
Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
Rate for Payer: VA VA |
$2,880.11
|
|
RECONSTRUCTION OF DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE ADVANCEMENT OR RELEASE (EG, CAMPBELL, GOLDWAITE TYPE PROCEDURE)
|
Facility
|
OP
|
$7,957.04
|
|
Service Code
|
CPT 27422
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$738.71 |
Max. Negotiated Rate |
$7,957.04 |
Rate for Payer: Aetna Medicare |
$6,620.26
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,957.04
|
Rate for Payer: Amish Plain Church Group Commercial |
$7,957.04
|
Rate for Payer: BCBS Complete |
$3,656.42
|
Rate for Payer: BCBS MAPPO |
$6,365.63
|
Rate for Payer: BCBS Trust/PPO |
$2,299.99
|
Rate for Payer: BCN Medicare Advantage |
$6,365.63
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,365.63
|
Rate for Payer: Mclaren Medicaid |
$3,482.00
|
Rate for Payer: Mclaren Medicare |
$6,365.63
|
Rate for Payer: Meridian Medicaid |
$3,656.42
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,683.91
|
Rate for Payer: MI Amish Medical Board Commercial |
$7,320.47
|
Rate for Payer: PACE Medicare |
$6,047.35
|
Rate for Payer: PACE SWMI |
$6,365.63
|
Rate for Payer: PHP Medicare Advantage |
$6,365.63
|
Rate for Payer: Priority Health Choice Medicaid |
$3,482.00
|
Rate for Payer: Priority Health Medicare |
$6,365.63
|
Rate for Payer: Railroad Medicare Medicare |
$6,365.63
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$812.58
|
Rate for Payer: UHC Core |
$6,837.00
|
Rate for Payer: UHC Dual Complete DSNP |
$6,365.63
|
Rate for Payer: UHC Exchange |
$738.71
|
Rate for Payer: UHC Medicare Advantage |
$6,556.60
|
Rate for Payer: VA VA |
$6,365.63
|
|
RECTAL RESECTION WITH CC
|
Facility
|
IP
|
$42,091.01
|
|
Service Code
|
MS-DRG 333
|
Min. Negotiated Rate |
$14,695.42 |
Max. Negotiated Rate |
$42,091.01 |
Rate for Payer: Aetna Medicare |
$16,087.61
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,336.08
|
Rate for Payer: Amish Plain Church Group Commercial |
$19,336.08
|
Rate for Payer: BCBS MAPPO |
$15,468.86
|
Rate for Payer: BCBS Trust/PPO |
$42,091.01
|
Rate for Payer: BCN Medicare Advantage |
$15,468.86
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,468.86
|
Rate for Payer: Mclaren Medicare |
$15,468.86
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,242.30
|
Rate for Payer: MI Amish Medical Board Commercial |
$17,789.19
|
Rate for Payer: PACE Medicare |
$14,695.42
|
Rate for Payer: PACE SWMI |
$15,468.86
|
Rate for Payer: PHP Medicare Advantage |
$15,468.86
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29,840.66
|
Rate for Payer: Priority Health Medicare |
$15,468.86
|
Rate for Payer: Priority Health Narrow Network |
$23,872.53
|
Rate for Payer: Railroad Medicare Medicare |
$15,468.86
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$31,720.69
|
Rate for Payer: UHC Core |
$19,464.12
|
Rate for Payer: UHC Dual Complete DSNP |
$15,468.86
|
Rate for Payer: UHC Exchange |
$20,846.99
|
Rate for Payer: UHC Medicare Advantage |
$15,932.93
|
Rate for Payer: VA VA |
$15,468.86
|
|
RECTAL RESECTION WITH MCC
|
Facility
|
IP
|
$59,908.54
|
|
Service Code
|
MS-DRG 332
|
Min. Negotiated Rate |
$25,469.73 |
Max. Negotiated Rate |
$59,908.54 |
Rate for Payer: Aetna Medicare |
$27,882.65
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,512.80
|
Rate for Payer: Amish Plain Church Group Commercial |
$33,512.80
|
Rate for Payer: BCBS MAPPO |
$26,810.24
|
Rate for Payer: BCBS Trust/PPO |
$59,908.54
|
Rate for Payer: BCN Medicare Advantage |
$26,810.24
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,810.24
|
Rate for Payer: Mclaren Medicare |
$26,810.24
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28,150.75
|
Rate for Payer: MI Amish Medical Board Commercial |
$30,831.78
|
Rate for Payer: PACE Medicare |
$25,469.73
|
Rate for Payer: PACE SWMI |
$26,810.24
|
Rate for Payer: PHP Medicare Advantage |
$26,810.24
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52,055.77
|
Rate for Payer: Priority Health Medicare |
$26,810.24
|
Rate for Payer: Priority Health Narrow Network |
$41,644.62
|
Rate for Payer: Railroad Medicare Medicare |
$26,810.24
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$55,335.41
|
Rate for Payer: UHC Core |
$33,954.34
|
Rate for Payer: UHC Dual Complete DSNP |
$26,810.24
|
Rate for Payer: UHC Exchange |
$36,366.69
|
Rate for Payer: UHC Medicare Advantage |
$27,614.55
|
Rate for Payer: VA VA |
$26,810.24
|
|
RECTAL RESECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$33,289.84
|
|
Service Code
|
MS-DRG 334
|
Min. Negotiated Rate |
$11,449.70 |
Max. Negotiated Rate |
$33,289.84 |
Rate for Payer: Aetna Medicare |
$12,534.41
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,065.40
|
Rate for Payer: Amish Plain Church Group Commercial |
$15,065.40
|
Rate for Payer: BCBS MAPPO |
$12,052.32
|
Rate for Payer: BCBS Trust/PPO |
$33,289.84
|
Rate for Payer: BCN Medicare Advantage |
$12,052.32
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,052.32
|
Rate for Payer: Mclaren Medicare |
$12,052.32
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,654.94
|
Rate for Payer: MI Amish Medical Board Commercial |
$13,860.17
|
Rate for Payer: PACE Medicare |
$11,449.70
|
Rate for Payer: PACE SWMI |
$12,052.32
|
Rate for Payer: PHP Medicare Advantage |
$12,052.32
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,033.06
|
Rate for Payer: Priority Health Medicare |
$12,052.32
|
Rate for Payer: Priority Health Narrow Network |
$18,426.45
|
Rate for Payer: Railroad Medicare Medicare |
$12,052.32
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$24,484.20
|
Rate for Payer: UHC Core |
$15,023.74
|
Rate for Payer: UHC Dual Complete DSNP |
$12,052.32
|
Rate for Payer: UHC Exchange |
$16,091.13
|
Rate for Payer: UHC Medicare Advantage |
$12,413.89
|
Rate for Payer: VA VA |
$12,052.32
|
|