|
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
|
$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) 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) 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
|
$1,544.90
|
|
|
Service Code
|
NDC 0186-0777-60
|
| Hospital Charge Code |
153169
|
|
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
|
|
|
TIGECYCLINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$231.11
|
|
|
Service Code
|
HCPCS J3243
|
| Hospital Charge Code |
41652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$196.44
|
| Rate for Payer: Aetna Commercial |
$93.42
|
| Rate for Payer: Aetna Commercial |
$100.22
|
| Rate for Payer: Aetna Commercial |
$69.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.64
|
| Rate for Payer: Cash Price |
$184.89
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$94.33
|
| Rate for Payer: Cash Price |
$87.93
|
| Rate for Payer: Cofinity Commercial |
$76.94
|
| Rate for Payer: Cofinity Commercial |
$70.63
|
| Rate for Payer: Cofinity Commercial |
$57.49
|
| Rate for Payer: Cofinity Commercial |
$161.78
|
| Rate for Payer: Cofinity Commercial |
$101.40
|
| Rate for Payer: Cofinity Commercial |
$82.54
|
| Rate for Payer: Cofinity Commercial |
$198.75
|
| Rate for Payer: Cofinity Commercial |
$94.52
|
| Rate for Payer: Healthscope Commercial |
$98.92
|
| Rate for Payer: Healthscope Commercial |
$106.12
|
| Rate for Payer: Healthscope Commercial |
$208.00
|
| Rate for Payer: Healthscope Commercial |
$73.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$196.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.81
|
| Rate for Payer: PHP Commercial |
$100.22
|
| Rate for Payer: PHP Commercial |
$196.44
|
| Rate for Payer: PHP Commercial |
$93.42
|
| Rate for Payer: PHP Commercial |
$69.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.94
|
| Rate for Payer: Priority Health SBD |
$69.24
|
| Rate for Payer: Priority Health SBD |
$74.28
|
| Rate for Payer: Priority Health SBD |
$51.74
|
| Rate for Payer: Priority Health SBD |
$145.60
|
|
|
TIMOLOL MALEATE 0.25 % EYE DROPS
|
Facility
|
IP
|
$19.13
|
|
|
Service Code
|
NDC 61314-226-10
|
| Hospital Charge Code |
11561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.43
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cofinity Commercial |
$13.39
|
| Rate for Payer: Cofinity Commercial |
$16.45
|
| Rate for Payer: Healthscope Commercial |
$17.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.26
|
| Rate for Payer: PHP Commercial |
$16.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.39
|
| Rate for Payer: Priority Health SBD |
$12.05
|
|
|
TIMOLOL MALEATE 0.25 % EYE DROPS
|
Facility
|
IP
|
$9.90
|
|
|
Service Code
|
NDC 61314-226-05
|
| Hospital Charge Code |
11561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$8.91 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.44
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$6.93
|
| Rate for Payer: Cofinity Commercial |
$8.51
|
| Rate for Payer: Healthscope Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.42
|
| Rate for Payer: PHP Commercial |
$8.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.93
|
| Rate for Payer: Priority Health SBD |
$6.24
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$31.57
|
|
|
Service Code
|
NDC 64980-514-05
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$28.41 |
| Rate for Payer: Aetna Commercial |
$26.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.52
|
| Rate for Payer: Cash Price |
$25.26
|
| Rate for Payer: Cofinity Commercial |
$27.15
|
| Rate for Payer: Cofinity Commercial |
$22.10
|
| Rate for Payer: Healthscope Commercial |
$28.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.83
|
| Rate for Payer: PHP Commercial |
$26.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.10
|
| Rate for Payer: Priority Health SBD |
$19.89
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$688.84
|
|
|
Service Code
|
NDC 24208-813-05
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$433.97 |
| Max. Negotiated Rate |
$619.96 |
| Rate for Payer: Aetna Commercial |
$585.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.75
|
| Rate for Payer: Cash Price |
$551.07
|
| Rate for Payer: Cofinity Commercial |
$482.19
|
| Rate for Payer: Cofinity Commercial |
$592.40
|
| Rate for Payer: Healthscope Commercial |
$619.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$585.51
|
| Rate for Payer: PHP Commercial |
$585.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.19
|
| Rate for Payer: Priority Health SBD |
$433.97
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$28.25
|
|
|
Service Code
|
NDC 17478-288-10
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$25.42 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.36
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$19.78
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Healthscope Commercial |
$25.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.01
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.78
|
| Rate for Payer: Priority Health SBD |
$17.80
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$22.91
|
|
|
Service Code
|
NDC 60758-801-05
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$19.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.89
|
| Rate for Payer: Cash Price |
$18.33
|
| Rate for Payer: Cofinity Commercial |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$19.70
|
| Rate for Payer: Healthscope Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.47
|
| Rate for Payer: PHP Commercial |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.04
|
| Rate for Payer: Priority Health SBD |
$14.43
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$19.71
|
|
|
Service Code
|
NDC 61314-227-05
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.42 |
| Max. Negotiated Rate |
$17.74 |
| Rate for Payer: Aetna Commercial |
$16.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.81
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$16.95
|
| Rate for Payer: Healthscope Commercial |
$17.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.75
|
| Rate for Payer: PHP Commercial |
$16.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.80
|
| Rate for Payer: Priority Health SBD |
$12.42
|
|
|
TISSUE EXPANDER PLACEMENT IN BREAST RECONSTRUCTION, INCLUDING SUBSEQUENT EXPANSION(S)
|
Facility
|
OP
|
$46,455.16
|
|
|
Service Code
|
CPT 19357
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,143.10 |
| Max. Negotiated Rate |
$46,455.16 |
| Rate for Payer: Aetna Medicare |
$16,307.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,599.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,599.81
|
| Rate for Payer: BCBS Complete |
$9,006.51
|
| Rate for Payer: BCBS MAPPO |
$15,679.85
|
| Rate for Payer: BCBS Trust/PPO |
$5,279.68
|
| Rate for Payer: BCN Medicare Advantage |
$15,679.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,679.85
|
| Rate for Payer: Mclaren Medicaid |
$8,576.88
|
| Rate for Payer: Mclaren Medicare |
$15,679.85
|
| Rate for Payer: Meridian Medicaid |
$9,006.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,463.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,031.83
|
| Rate for Payer: PACE Medicare |
$14,895.86
|
| Rate for Payer: PACE SWMI |
$15,679.85
|
| Rate for Payer: PHP Medicare Advantage |
$15,679.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,576.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46,455.16
|
| Rate for Payer: Priority Health Medicare |
$15,679.85
|
| Rate for Payer: Priority Health Narrow Network |
$37,164.13
|
| Rate for Payer: Railroad Medicare Medicare |
$15,679.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,257.41
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,679.85
|
| Rate for Payer: UHC Exchange |
$1,143.10
|
| Rate for Payer: UHC Medicare Advantage |
$16,150.25
|
| Rate for Payer: VA VA |
$15,679.85
|
|
