|
THIAMINE HCL (VITAMIN B1) 100 MG TABLET
|
Facility
IP
|
$177.43
|
|
|
Service Code
|
NDC 5026885115
|
| Hospital Charge Code |
7877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.78 |
| Max. Negotiated Rate |
$159.69 |
| Rate for Payer: Aetna Commercial |
$150.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.33
|
| Rate for Payer: Cash Price |
$141.94
|
| Rate for Payer: Cofinity Commercial |
$124.20
|
| Rate for Payer: Cofinity Commercial |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$159.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.82
|
| Rate for Payer: PHP Commercial |
$150.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.20
|
| Rate for Payer: Priority Health SBD |
$111.78
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG TABLET
|
Facility
IP
|
$3.55
|
|
|
Service Code
|
NDC 5026885111
|
| Hospital Charge Code |
7877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.31
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.02
|
| Rate for Payer: PHP Commercial |
$3.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.48
|
| Rate for Payer: Priority Health SBD |
$2.24
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
IP
|
$411.25
|
|
|
Service Code
|
NDC 6809411661
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.09 |
| Max. Negotiated Rate |
$370.12 |
| Rate for Payer: Aetna Commercial |
$349.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.31
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$287.88
|
| Rate for Payer: Cofinity Commercial |
$353.68
|
| Rate for Payer: Healthscope Commercial |
$370.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$349.56
|
| Rate for Payer: PHP Commercial |
$349.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.88
|
| Rate for Payer: Priority Health SBD |
$259.09
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
IP
|
$4.12
|
|
|
Service Code
|
NDC 6809411659
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.68
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Commercial |
$2.88
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$3.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.50
|
| Rate for Payer: PHP Commercial |
$3.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.88
|
| Rate for Payer: Priority Health SBD |
$2.60
|
|
|
THIORIDAZINE 100 MG TABLET
|
Facility
IP
|
$426.24
|
|
|
Service Code
|
NDC 0378-0618-01
|
| Hospital Charge Code |
7895
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$268.53 |
| Max. Negotiated Rate |
$383.62 |
| Rate for Payer: Aetna Commercial |
$362.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.06
|
| Rate for Payer: Cash Price |
$340.99
|
| Rate for Payer: Cofinity Commercial |
$298.37
|
| Rate for Payer: Cofinity Commercial |
$366.57
|
| Rate for Payer: Healthscope Commercial |
$383.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$362.30
|
| Rate for Payer: PHP Commercial |
$362.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.37
|
| Rate for Payer: Priority Health SBD |
$268.53
|
|
|
THIORIDAZINE 100 MG TABLET
|
Facility
IP
|
$337.44
|
|
|
Service Code
|
NDC 51079-580-20
|
| Hospital Charge Code |
7895
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.59 |
| Max. Negotiated Rate |
$303.70 |
| Rate for Payer: Aetna Commercial |
$286.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.34
|
| Rate for Payer: Cash Price |
$269.95
|
| Rate for Payer: Cofinity Commercial |
$236.21
|
| Rate for Payer: Cofinity Commercial |
$290.20
|
| Rate for Payer: Healthscope Commercial |
$303.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$286.82
|
| Rate for Payer: PHP Commercial |
$286.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.21
|
| Rate for Payer: Priority Health SBD |
$212.59
|
|
|
THIORIDAZINE 100 MG TABLET
|
Facility
IP
|
$3.38
|
|
|
Service Code
|
NDC 51079-580-01
|
| Hospital Charge Code |
7895
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Healthscope Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.87
|
| Rate for Payer: PHP Commercial |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: Priority Health SBD |
$2.13
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
IP
|
$299.04
|
|
|
Service Code
|
NDC 0378-0614-01
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.40 |
| Max. Negotiated Rate |
$269.14 |
| Rate for Payer: Aetna Commercial |
$254.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.38
|
| Rate for Payer: Cash Price |
$239.23
|
| Rate for Payer: Cofinity Commercial |
$209.33
|
| Rate for Payer: Cofinity Commercial |
$257.17
|
| Rate for Payer: Healthscope Commercial |
$269.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.18
|
| Rate for Payer: PHP Commercial |
$254.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.33
|
| Rate for Payer: Priority Health SBD |
$188.40
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
IP
|
$4.69
|
|
|
Service Code
|
NDC 51079-566-01
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.05
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: Cofinity Commercial |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$4.03
|
| Rate for Payer: Healthscope Commercial |
$4.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.99
|
| Rate for Payer: PHP Commercial |
$3.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.28
|
| Rate for Payer: Priority Health SBD |
$2.95
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
IP
|
$468.35
|
|
|
Service Code
|
NDC 51079-566-20
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$295.06 |
| Max. Negotiated Rate |
$421.52 |
| Rate for Payer: Aetna Commercial |
$398.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.43
|
| Rate for Payer: Cash Price |
$374.68
|
| Rate for Payer: Cofinity Commercial |
$327.84
|
| Rate for Payer: Cofinity Commercial |
$402.78
|
| Rate for Payer: Healthscope Commercial |
$421.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$398.10
|
| Rate for Payer: PHP Commercial |
$398.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.84
|
| Rate for Payer: Priority Health SBD |
$295.06
|
|
|
THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGING GUIDANCE
|
Facility
OP
|
$1,683.01
|
|
|
Service Code
|
CPT 32555
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.78 |
| Max. Negotiated Rate |
$1,683.01 |
| Rate for Payer: Aetna Medicare |
$581.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.71
|
| Rate for Payer: BCBS Complete |
$321.07
|
| Rate for Payer: BCBS MAPPO |
$558.97
|
| Rate for Payer: BCBS Trust/PPO |
$406.57
|
| Rate for Payer: BCN Medicare Advantage |
$558.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.97
|
| Rate for Payer: Mclaren Medicaid |
$305.76
|
| Rate for Payer: Mclaren Medicare |
$558.97
|
| Rate for Payer: Meridian Medicaid |
$321.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.82
|
| Rate for Payer: PACE Medicare |
$531.02
|
| Rate for Payer: PACE SWMI |
$558.97
|
| Rate for Payer: PHP Medicare Advantage |
$558.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,683.01
|
| Rate for Payer: Priority Health Medicare |
$558.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,346.41
|
| Rate for Payer: Railroad Medicare Medicare |
$558.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.26
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.97
|
| Rate for Payer: UHC Exchange |
$104.78
|
| Rate for Payer: UHC Medicare Advantage |
$575.74
|
| Rate for Payer: VA VA |
$558.97
|
|
|
THROMBECTOMY, OPEN, ARTERIOVENOUS FISTULA WITHOUT REVISION, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)
|
Facility
OP
|
$15,411.76
|
|
|
Service Code
|
CPT 36831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.98 |
| Max. Negotiated Rate |
$15,411.76 |
| Rate for Payer: Aetna Medicare |
$5,085.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,112.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,112.15
|
| Rate for Payer: BCBS Complete |
$2,808.66
|
| Rate for Payer: BCBS MAPPO |
$4,889.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,635.37
|
| Rate for Payer: BCN Medicare Advantage |
$4,889.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,889.72
|
| Rate for Payer: Mclaren Medicaid |
$2,674.68
|
| Rate for Payer: Mclaren Medicare |
$4,889.72
|
| Rate for Payer: Meridian Medicaid |
$2,808.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,134.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,623.18
|
| Rate for Payer: PACE Medicare |
$4,645.23
|
| Rate for Payer: PACE SWMI |
$4,889.72
|
| Rate for Payer: PHP Medicare Advantage |
$4,889.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,674.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,411.76
|
| Rate for Payer: Priority Health Medicare |
$4,889.72
|
| Rate for Payer: Priority Health Narrow Network |
$12,329.41
|
| Rate for Payer: Railroad Medicare Medicare |
$4,889.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$653.38
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,889.72
|
| Rate for Payer: UHC Exchange |
$593.98
|
| Rate for Payer: UHC Medicare Advantage |
$5,036.41
|
| Rate for Payer: VA VA |
$4,889.72
|
|
|
THROMBIN 5000UNITS/EPINEPHRINE TOPICAL 30ML/NS 1L
|
Facility
IP
|
$218.05
|
|
|
Service Code
|
NDC 9900-0002-00
|
| Hospital Charge Code |
500527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$137.37 |
| Max. Negotiated Rate |
$196.24 |
| Rate for Payer: Aetna Commercial |
$185.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.73
|
| Rate for Payer: Cash Price |
$174.44
|
| Rate for Payer: Cofinity Commercial |
$152.64
|
| Rate for Payer: Cofinity Commercial |
$187.52
|
| Rate for Payer: Healthscope Commercial |
$196.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.34
|
| Rate for Payer: PHP Commercial |
$185.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.64
|
| Rate for Payer: Priority Health SBD |
$137.37
|
|
|
THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY
|
Facility
IP
|
$795.39
|
|
|
Service Code
|
NDC 60793-217-22
|
| Hospital Charge Code |
108841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$501.10 |
| Max. Negotiated Rate |
$715.85 |
| Rate for Payer: Aetna Commercial |
$676.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.00
|
| Rate for Payer: Cash Price |
$636.31
|
| Rate for Payer: Cofinity Commercial |
$556.77
|
| Rate for Payer: Cofinity Commercial |
$684.04
|
| Rate for Payer: Healthscope Commercial |
$715.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$676.08
|
| Rate for Payer: PHP Commercial |
$676.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$556.77
|
| Rate for Payer: Priority Health SBD |
$501.10
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SOLUTION
|
Facility
IP
|
$176.24
|
|
|
Service Code
|
NDC 60793-215-05
|
| Hospital Charge Code |
117741
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$111.03 |
| Max. Negotiated Rate |
$158.62 |
| Rate for Payer: Aetna Commercial |
$149.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.56
|
| Rate for Payer: Cash Price |
$140.99
|
| Rate for Payer: Cofinity Commercial |
$123.37
|
| Rate for Payer: Cofinity Commercial |
$151.57
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.80
|
| Rate for Payer: PHP Commercial |
$149.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.37
|
| Rate for Payer: Priority Health SBD |
$111.03
|
|
|
THYROIDECTOMY, TOTAL OR COMPLETE
|
Facility
OP
|
$15,628.84
|
|
|
Service Code
|
CPT 60240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$903.41 |
| Max. Negotiated Rate |
$15,628.84 |
| Rate for Payer: Aetna Medicare |
$5,339.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,417.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,417.61
|
| Rate for Payer: BCBS Complete |
$2,949.02
|
| Rate for Payer: BCBS MAPPO |
$5,134.09
|
| Rate for Payer: BCBS Trust/PPO |
$4,100.05
|
| Rate for Payer: BCN Medicare Advantage |
$5,134.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,134.09
|
| Rate for Payer: Mclaren Medicaid |
$2,808.35
|
| Rate for Payer: Mclaren Medicare |
$5,134.09
|
| Rate for Payer: Meridian Medicaid |
$2,949.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,390.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,904.20
|
| Rate for Payer: PACE Medicare |
$4,877.39
|
| Rate for Payer: PACE SWMI |
$5,134.09
|
| Rate for Payer: PHP Medicare Advantage |
$5,134.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,808.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,628.84
|
| Rate for Payer: Priority Health Medicare |
$5,134.09
|
| Rate for Payer: Priority Health Narrow Network |
$12,503.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5,134.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$993.75
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$903.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC
|
Facility
IP
|
$29,328.44
|
|
|
Service Code
|
MS-DRG 626
|
| Min. Negotiated Rate |
$10,675.23 |
| Max. Negotiated Rate |
$29,328.44 |
| Rate for Payer: Aetna Medicare |
$11,686.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,046.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,046.35
|
| Rate for Payer: BCBS MAPPO |
$11,237.08
|
| Rate for Payer: BCBS Trust/PPO |
$29,328.44
|
| Rate for Payer: BCN Medicare Advantage |
$11,237.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,237.08
|
| Rate for Payer: Mclaren Medicare |
$11,237.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,798.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,922.64
|
| Rate for Payer: PACE Medicare |
$10,675.23
|
| Rate for Payer: PACE SWMI |
$11,237.08
|
| Rate for Payer: PHP Medicare Advantage |
$11,237.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,408.65
|
| Rate for Payer: Priority Health Medicare |
$11,237.08
|
| Rate for Payer: Priority Health Narrow Network |
$17,126.92
|
| Rate for Payer: Railroad Medicare Medicare |
$11,237.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,757.44
|
| Rate for Payer: UHC Core |
$13,964.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,237.08
|
| Rate for Payer: UHC Exchange |
$14,956.30
|
| Rate for Payer: UHC Medicare Advantage |
$11,574.19
|
| Rate for Payer: VA VA |
$11,237.08
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC
|
Facility
IP
|
$44,559.98
|
|
|
Service Code
|
MS-DRG 625
|
| Min. Negotiated Rate |
$20,454.07 |
| Max. Negotiated Rate |
$44,559.98 |
| Rate for Payer: Aetna Medicare |
$22,391.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,913.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,913.25
|
| Rate for Payer: BCBS MAPPO |
$21,530.60
|
| Rate for Payer: BCBS Trust/PPO |
$39,508.63
|
| Rate for Payer: BCN Medicare Advantage |
$21,530.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,530.60
|
| Rate for Payer: Mclaren Medicare |
$21,530.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,607.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,760.19
|
| Rate for Payer: PACE Medicare |
$20,454.07
|
| Rate for Payer: PACE SWMI |
$21,530.60
|
| Rate for Payer: PHP Medicare Advantage |
$21,530.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41,918.99
|
| Rate for Payer: Priority Health Medicare |
$21,530.60
|
| Rate for Payer: Priority Health Narrow Network |
$33,535.19
|
| Rate for Payer: Railroad Medicare Medicare |
$21,530.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,559.98
|
| Rate for Payer: UHC Core |
$27,342.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,530.60
|
| Rate for Payer: UHC Exchange |
$29,285.03
|
| Rate for Payer: UHC Medicare Advantage |
$22,176.52
|
| Rate for Payer: VA VA |
$21,530.60
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$24,297.63
|
|
|
Service Code
|
MS-DRG 627
|
| Min. Negotiated Rate |
$8,924.44 |
| Max. Negotiated Rate |
$24,297.63 |
| Rate for Payer: Aetna Medicare |
$9,769.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,742.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,742.69
|
| Rate for Payer: BCBS MAPPO |
$9,394.15
|
| Rate for Payer: BCBS Trust/PPO |
$24,297.63
|
| Rate for Payer: BCN Medicare Advantage |
$9,394.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,394.15
|
| Rate for Payer: Mclaren Medicare |
$9,394.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,863.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,803.27
|
| Rate for Payer: PACE Medicare |
$8,924.44
|
| Rate for Payer: PACE SWMI |
$9,394.15
|
| Rate for Payer: PHP Medicare Advantage |
$9,394.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,736.50
|
| Rate for Payer: Priority Health Medicare |
$9,394.15
|
| Rate for Payer: Priority Health Narrow Network |
$14,189.20
|
| Rate for Payer: Railroad Medicare Medicare |
$9,394.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,853.94
|
| Rate for Payer: UHC Core |
$11,568.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,394.15
|
| Rate for Payer: UHC Exchange |
$12,390.90
|
| Rate for Payer: UHC Medicare Advantage |
$9,675.97
|
| Rate for Payer: VA VA |
$9,394.15
|
|
|
THYROID (PORK) 30 MG TABLET
|
Facility
IP
|
$429.60
|
|
|
Service Code
|
NDC 0456-0458-01
|
| Hospital Charge Code |
119104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.65 |
| Max. Negotiated Rate |
$386.64 |
| Rate for Payer: Aetna Commercial |
$365.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.24
|
| Rate for Payer: Cash Price |
$343.68
|
| Rate for Payer: Cofinity Commercial |
$300.72
|
| Rate for Payer: Cofinity Commercial |
$369.46
|
| Rate for Payer: Healthscope Commercial |
$386.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.16
|
| Rate for Payer: PHP Commercial |
$365.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.72
|
| Rate for Payer: Priority Health SBD |
$270.65
|
|
|
THYROID (PORK) 30 MG TABLET
|
Facility
IP
|
$307.20
|
|
|
Service Code
|
NDC 42192-329-01
|
| Hospital Charge Code |
119104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.54 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$261.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.68
|
| Rate for Payer: Cash Price |
$245.76
|
| Rate for Payer: Cofinity Commercial |
$215.04
|
| Rate for Payer: Cofinity Commercial |
$264.19
|
| Rate for Payer: Healthscope Commercial |
$276.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$261.12
|
| Rate for Payer: PHP Commercial |
$261.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.04
|
| Rate for Payer: Priority Health SBD |
$193.54
|
|
|
THYROID (PORK) 60 MG TABLET
|
Facility
IP
|
$477.60
|
|
|
Service Code
|
NDC 0456-0459-01
|
| Hospital Charge Code |
119105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$300.89 |
| Max. Negotiated Rate |
$429.84 |
| Rate for Payer: Aetna Commercial |
$405.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.44
|
| Rate for Payer: Cash Price |
$382.08
|
| Rate for Payer: Cofinity Commercial |
$334.32
|
| Rate for Payer: Cofinity Commercial |
$410.74
|
| Rate for Payer: Healthscope Commercial |
$429.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.96
|
| Rate for Payer: PHP Commercial |
$405.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.32
|
| Rate for Payer: Priority Health SBD |
$300.89
|
|
|
THYROTROPIN ALFA 0.9 MG INTRAMUSCULAR SOLUTION
|
Facility
OP
|
$6,172.85
|
|
|
Service Code
|
HCPCS J3240
|
| Hospital Charge Code |
196901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,105.58 |
| Max. Negotiated Rate |
$5,983.71 |
| Rate for Payer: Aetna Commercial |
$5,246.92
|
| Rate for Payer: Aetna Medicare |
$2,102.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,012.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,526.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,526.46
|
| Rate for Payer: BCBS Complete |
$1,160.96
|
| Rate for Payer: BCBS MAPPO |
$2,021.17
|
| Rate for Payer: BCBS Trust/PPO |
$5,983.71
|
| Rate for Payer: BCN Medicare Advantage |
$2,021.17
|
| Rate for Payer: Cash Price |
$4,938.28
|
| Rate for Payer: Cash Price |
$4,938.28
|
| Rate for Payer: Cofinity Commercial |
$4,321.00
|
| Rate for Payer: Cofinity Commercial |
$5,308.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,021.17
|
| Rate for Payer: Healthscope Commercial |
$5,555.56
|
| Rate for Payer: Mclaren Medicaid |
$1,105.58
|
| Rate for Payer: Mclaren Medicare |
$2,021.17
|
| Rate for Payer: Meridian Medicaid |
$1,160.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,122.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,324.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,246.92
|
| Rate for Payer: PACE Medicare |
$1,920.11
|
| Rate for Payer: PACE SWMI |
$2,021.17
|
| Rate for Payer: PHP Commercial |
$5,246.92
|
| Rate for Payer: PHP Medicare Advantage |
$2,021.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,105.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,321.00
|
| Rate for Payer: Priority Health Medicare |
$2,021.17
|
| Rate for Payer: Priority Health SBD |
$3,888.90
|
| Rate for Payer: Railroad Medicare Medicare |
$2,021.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,021.17
|
| Rate for Payer: UHC Medicare Advantage |
$2,081.81
|
| Rate for Payer: VA VA |
$2,021.17
|
|
|
TICAGRELOR 60 MG TABLET
|
Facility
IP
|
$1,544.90
|
|
|
Service Code
|
NDC 0186-0776-60
|
| Hospital Charge Code |
175597
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$973.29 |
| Max. Negotiated Rate |
$1,390.41 |
| Rate for Payer: Aetna Commercial |
$1,313.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.18
|
| Rate for Payer: Cash Price |
$1,235.92
|
| Rate for Payer: Cofinity Commercial |
$1,081.43
|
| Rate for Payer: Cofinity Commercial |
$1,328.61
|
| Rate for Payer: Healthscope Commercial |
$1,390.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,313.16
|
| Rate for Payer: PHP Commercial |
$1,313.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,081.43
|
| Rate for Payer: Priority Health SBD |
$973.29
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
IP
|
$2,574.83
|
|
|
Service Code
|
NDC 0186-0777-39
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,622.14 |
| Max. Negotiated Rate |
$2,317.35 |
| Rate for Payer: Aetna Commercial |
$2,188.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,673.64
|
| Rate for Payer: Cash Price |
$2,059.86
|
| Rate for Payer: Cofinity Commercial |
$1,802.38
|
| Rate for Payer: Cofinity Commercial |
$2,214.35
|
| Rate for Payer: Healthscope Commercial |
$2,317.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,188.61
|
| Rate for Payer: PHP Commercial |
$2,188.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,802.38
|
| Rate for Payer: Priority Health SBD |
$1,622.14
|
|
