|
INTRAOCULAR PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$28,943.58
|
|
|
Service Code
|
MS-DRG 116
|
| Min. Negotiated Rate |
$13,889.52 |
| Max. Negotiated Rate |
$28,943.58 |
| Rate for Payer: Aetna Medicare |
$15,205.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,275.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,275.69
|
| Rate for Payer: BCBS MAPPO |
$14,620.55
|
| Rate for Payer: BCBS Trust/PPO |
$28,943.58
|
| Rate for Payer: BCN Medicare Advantage |
$14,620.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,620.55
|
| Rate for Payer: Mclaren Medicare |
$14,620.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,351.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,813.63
|
| Rate for Payer: PACE Medicare |
$13,889.52
|
| Rate for Payer: PACE SWMI |
$14,620.55
|
| Rate for Payer: PHP Medicare Advantage |
$14,620.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,271.83
|
| Rate for Payer: Priority Health Medicare |
$14,620.55
|
| Rate for Payer: Priority Health Narrow Network |
$21,017.46
|
| Rate for Payer: Railroad Medicare Medicare |
$14,620.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,927.02
|
| Rate for Payer: UHC Core |
$22,899.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,620.55
|
| Rate for Payer: UHC Exchange |
$18,205.48
|
| Rate for Payer: UHC Medicare Advantage |
$15,059.17
|
| Rate for Payer: VA VA |
$14,620.55
|
|
|
INTRAOCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$24,071.07
|
|
|
Service Code
|
MS-DRG 117
|
| Min. Negotiated Rate |
$9,259.89 |
| Max. Negotiated Rate |
$24,071.07 |
| Rate for Payer: Aetna Medicare |
$10,137.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,184.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,184.06
|
| Rate for Payer: BCBS MAPPO |
$9,747.25
|
| Rate for Payer: BCBS Trust/PPO |
$24,071.07
|
| Rate for Payer: BCN Medicare Advantage |
$9,747.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,747.25
|
| Rate for Payer: Mclaren Medicare |
$9,747.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,234.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,209.34
|
| Rate for Payer: PACE Medicare |
$9,259.89
|
| Rate for Payer: PACE SWMI |
$9,747.25
|
| Rate for Payer: PHP Medicare Advantage |
$9,747.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,196.94
|
| Rate for Payer: Priority Health Medicare |
$9,747.25
|
| Rate for Payer: Priority Health Narrow Network |
$13,757.55
|
| Rate for Payer: Railroad Medicare Medicare |
$9,747.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,280.39
|
| Rate for Payer: UHC Core |
$14,989.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,747.25
|
| Rate for Payer: UHC Exchange |
$11,916.89
|
| Rate for Payer: UHC Medicare Advantage |
$10,039.67
|
| Rate for Payer: VA VA |
$9,747.25
|
|
|
INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR FLOOR OF MOUTH; SUBMANDIBULAR SPACE
|
Facility
|
OP
|
$9,009.23
|
|
|
Service Code
|
CPT 41008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$254.42 |
| Max. Negotiated Rate |
$9,009.23 |
| Rate for Payer: Aetna Medicare |
$2,976.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,396.54
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,009.23
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$7,207.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.86
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,861.84
|
| Rate for Payer: UHC Exchange |
$254.42
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
INTRAVASCULAR ULTRASOUND (NONCORONARY VESSEL) DURING DIAGNOSTIC EVALUATION AND/OR THERAPEUTIC INTERVENTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; EACH ADDITIONAL NONCORONARY VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$794.25
|
|
|
Service Code
|
CPT 37253
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$67.45 |
| Max. Negotiated Rate |
$794.25 |
| Rate for Payer: BCBS Trust/PPO |
$794.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.20
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$67.45
|
|
|
INTRAVASCULAR ULTRASOUND (NONCORONARY VESSEL) DURING DIAGNOSTIC EVALUATION AND/OR THERAPEUTIC INTERVENTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; INITIAL NONCORONARY VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$5,382.94
|
|
|
Service Code
|
CPT 37252
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$84.81 |
| Max. Negotiated Rate |
$5,382.94 |
| Rate for Payer: BCBS Trust/PPO |
$5,382.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.29
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$84.81
|
|
|
INTRAVENOUS INJECTION OF AGENT (EG, FLUORESCEIN) TO TEST VASCULAR FLOW IN FLAP OR GRAFT
|
Facility
|
OP
|
$1,114.93
|
|
|
Service Code
|
CPT 15860
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.47 |
| Max. Negotiated Rate |
$1,114.93 |
| Rate for Payer: Aetna Medicare |
$368.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$442.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$442.70
|
| Rate for Payer: BCBS Complete |
$203.43
|
| Rate for Payer: BCBS MAPPO |
$354.16
|
| Rate for Payer: BCBS Trust/PPO |
$234.77
|
| Rate for Payer: BCN Medicare Advantage |
$354.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.16
|
| Rate for Payer: Mclaren Medicaid |
$193.73
|
| Rate for Payer: Mclaren Medicare |
$354.16
|
| Rate for Payer: Meridian Medicaid |
$203.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$371.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.28
|
| Rate for Payer: PACE Medicare |
$336.45
|
| Rate for Payer: PACE SWMI |
$354.16
|
| Rate for Payer: PHP Medicare Advantage |
$354.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,114.93
|
| Rate for Payer: Priority Health Medicare |
$354.16
|
| Rate for Payer: Priority Health Narrow Network |
$891.94
|
| Rate for Payer: Railroad Medicare Medicare |
$354.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.82
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.16
|
| Rate for Payer: UHC Exchange |
$103.47
|
| Rate for Payer: UHC Medicare Advantage |
$364.78
|
| Rate for Payer: VA VA |
$354.16
|
|
|
INTRODUCTION OF CATHETER, AORTA
|
Facility
|
OP
|
$1,833.52
|
|
|
Service Code
|
CPT 36200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$133.27 |
| Max. Negotiated Rate |
$1,833.52 |
| Rate for Payer: BCBS Trust/PPO |
$1,833.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.60
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$133.27
|
|
|
INTRODUCTION OF CATHETER, AORTA
|
Facility
|
OP
|
$1,833.52
|
|
|
Service Code
|
CPT 36200
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$133.27 |
| Max. Negotiated Rate |
$1,833.52 |
| Rate for Payer: BCBS Trust/PPO |
$1,833.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.60
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$133.27
|
|
|
INTRODUCTION OF CATHETER, SUPERIOR OR INFERIOR VENA CAVA
|
Facility
|
OP
|
$1,651.59
|
|
|
Service Code
|
CPT 36010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.80 |
| Max. Negotiated Rate |
$1,651.59 |
| Rate for Payer: BCBS Trust/PPO |
$1,651.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.18
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$103.80
|
|
|
INTRODUCTION OF NEEDLE OR INTRACATHETER, UPPER OR LOWER EXTREMITY ARTERY
|
Facility
|
OP
|
$1,444.41
|
|
|
Service Code
|
CPT 36140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$85.13 |
| Max. Negotiated Rate |
$1,444.41 |
| Rate for Payer: BCBS Trust/PPO |
$1,444.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.64
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$85.13
|
|
|
INTRODUCTION OF NEEDLE(S) AND/OR CATHETER(S), DIALYSIS CIRCUIT, WITH DIAGNOSTIC ANGIOGRAPHY OF THE DIALYSIS CIRCUIT, INCLUDING ALL DIRECT PUNCTURE(S) AND CATHETER PLACEMENT(S), INJECTION(S) OF CONTRAST, ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA, FLUOROSCOPIC GUIDANCE, RADIOLOGICAL SUPERVISION AND INTERPRETATION AND IMAGE DOCUMENTATION AND REPORT;
|
Facility
|
OP
|
$4,481.48
|
|
|
Service Code
|
CPT 36901
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$160.45 |
| Max. Negotiated Rate |
$4,481.48 |
| Rate for Payer: Aetna Medicare |
$1,480.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,779.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,779.46
|
| Rate for Payer: BCBS Complete |
$817.70
|
| Rate for Payer: BCBS MAPPO |
$1,423.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,591.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,423.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,423.57
|
| Rate for Payer: Mclaren Medicaid |
$778.69
|
| Rate for Payer: Mclaren Medicare |
$1,423.57
|
| Rate for Payer: Meridian Medicaid |
$817.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,494.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,637.11
|
| Rate for Payer: PACE Medicare |
$1,352.39
|
| Rate for Payer: PACE SWMI |
$1,423.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,423.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$778.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,481.48
|
| Rate for Payer: Priority Health Medicare |
$1,423.57
|
| Rate for Payer: Priority Health Narrow Network |
$3,585.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,423.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.50
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,423.57
|
| Rate for Payer: UHC Exchange |
$160.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,466.28
|
| Rate for Payer: VA VA |
$1,423.57
|
|
|
INTRODUCTION OF NEEDLE(S) AND/OR CATHETER(S), DIALYSIS CIRCUIT, WITH DIAGNOSTIC ANGIOGRAPHY OF THE DIALYSIS CIRCUIT, INCLUDING ALL DIRECT PUNCTURE(S) AND CATHETER PLACEMENT(S), INJECTION(S) OF CONTRAST, ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA, FLUOROSCOPIC GUIDANCE, RADIOLOGICAL SUPERVISION AND INTERPRETATION AND IMAGE DOCUMENTATION AND REPORT; WITH TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENT(S), PERIPHERAL DIALYSIS SEGMENT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE STENTING, AND ALL ANGIOPLASTY WITHIN THE PERIPHERAL DIALYSIS SEGMENT
|
Facility
|
OP
|
$30,783.77
|
|
|
Service Code
|
CPT 36903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$300.92 |
| Max. Negotiated Rate |
$30,783.77 |
| Rate for Payer: Aetna Medicare |
$10,169.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,223.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,223.36
|
| Rate for Payer: BCBS Complete |
$5,616.88
|
| Rate for Payer: BCBS MAPPO |
$9,778.69
|
| Rate for Payer: BCBS Trust/PPO |
$9,788.60
|
| Rate for Payer: BCN Medicare Advantage |
$9,778.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,778.69
|
| Rate for Payer: Mclaren Medicaid |
$5,348.94
|
| Rate for Payer: Mclaren Medicare |
$9,778.69
|
| Rate for Payer: Meridian Medicaid |
$5,616.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,267.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,245.49
|
| Rate for Payer: PACE Medicare |
$9,289.76
|
| Rate for Payer: PACE SWMI |
$9,778.69
|
| Rate for Payer: PHP Medicare Advantage |
$9,778.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,348.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,783.77
|
| Rate for Payer: Priority Health Medicare |
$9,778.69
|
| Rate for Payer: Priority Health Narrow Network |
$24,627.02
|
| Rate for Payer: Railroad Medicare Medicare |
$9,778.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$331.01
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,778.69
|
| Rate for Payer: UHC Exchange |
$300.92
|
| Rate for Payer: UHC Medicare Advantage |
$10,072.05
|
| Rate for Payer: VA VA |
$9,778.69
|
|
|
INTRODUCTION OF NEEDLE(S) AND/OR CATHETER(S), DIALYSIS CIRCUIT, WITH DIAGNOSTIC ANGIOGRAPHY OF THE DIALYSIS CIRCUIT, INCLUDING ALL DIRECT PUNCTURE(S) AND CATHETER PLACEMENT(S), INJECTION(S) OF CONTRAST, ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA, FLUOROSCOPIC GUIDANCE, RADIOLOGICAL SUPERVISION AND INTERPRETATION AND IMAGE DOCUMENTATION AND REPORT; WITH TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL DIALYSIS SEGMENT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY
|
Facility
|
OP
|
$15,993.75
|
|
|
Service Code
|
CPT 36902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$228.88 |
| Max. Negotiated Rate |
$15,993.75 |
| Rate for Payer: Aetna Medicare |
$5,283.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,350.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,350.66
|
| Rate for Payer: BCBS Complete |
$2,918.26
|
| Rate for Payer: BCBS MAPPO |
$5,080.53
|
| Rate for Payer: BCBS Trust/PPO |
$3,539.05
|
| Rate for Payer: BCN Medicare Advantage |
$5,080.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,080.53
|
| Rate for Payer: Mclaren Medicaid |
$2,779.05
|
| Rate for Payer: Mclaren Medicare |
$5,080.53
|
| Rate for Payer: Meridian Medicaid |
$2,918.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,334.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,842.61
|
| Rate for Payer: PACE Medicare |
$4,826.50
|
| Rate for Payer: PACE SWMI |
$5,080.53
|
| Rate for Payer: PHP Medicare Advantage |
$5,080.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,779.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,993.75
|
| Rate for Payer: Priority Health Medicare |
$5,080.53
|
| Rate for Payer: Priority Health Narrow Network |
$12,795.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5,080.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.77
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,080.53
|
| Rate for Payer: UHC Exchange |
$228.88
|
| Rate for Payer: UHC Medicare Advantage |
$5,232.95
|
| Rate for Payer: VA VA |
$5,080.53
|
|
|
INTUBATION, ENDOTRACHEAL, EMERGENCY PROCEDURE
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 31500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$118.76 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$225.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$271.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$271.40
|
| Rate for Payer: BCBS Complete |
$124.71
|
| Rate for Payer: BCBS MAPPO |
$217.12
|
| Rate for Payer: BCBS Trust/PPO |
$222.25
|
| Rate for Payer: BCN Medicare Advantage |
$217.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.12
|
| Rate for Payer: Mclaren Medicaid |
$118.76
|
| Rate for Payer: Mclaren Medicare |
$217.12
|
| Rate for Payer: Meridian Medicaid |
$124.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$227.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.69
|
| Rate for Payer: PACE Medicare |
$206.26
|
| Rate for Payer: PACE SWMI |
$217.12
|
| Rate for Payer: PHP Medicare Advantage |
$217.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$683.51
|
| Rate for Payer: Priority Health Medicare |
$217.12
|
| Rate for Payer: Priority Health Narrow Network |
$546.81
|
| Rate for Payer: Railroad Medicare Medicare |
$217.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.19
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.12
|
| Rate for Payer: UHC Exchange |
$136.54
|
| Rate for Payer: UHC Medicare Advantage |
$223.63
|
| Rate for Payer: VA VA |
$217.12
|
|
|
IODINE-SODIUM IODIDE 2 % TOPICAL TINCTURE
|
Facility
|
IP
|
$82.78
|
|
|
Service Code
|
NDC 0395-1213-16
|
| Hospital Charge Code |
19490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$74.50 |
| Rate for Payer: Aetna American Axle |
$53.81
|
| Rate for Payer: Aetna Commercial |
$70.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.81
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Commercial |
$57.95
|
| Rate for Payer: Cofinity Commercial |
$71.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Healthscope Commercial |
$74.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.36
|
| Rate for Payer: PHP Commercial |
$70.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.95
|
| Rate for Payer: Priority Health SBD |
$52.15
|
| Rate for Payer: UMR Bronson Commercial |
$36.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.08
|
|
|
IODINE-SODIUM IODIDE 2 % TOPICAL TINCTURE
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
NDC 0869-3851-10
|
| Hospital Charge Code |
19490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna American Axle |
$6.76
|
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.76
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.84
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.28
|
| Rate for Payer: Priority Health SBD |
$6.55
|
| Rate for Payer: UMR Bronson Commercial |
$4.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
|
IODINE-SODIUM IODIDE 2 % TOPICAL TINCTURE
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 0990-0000-77
|
| Hospital Charge Code |
19490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Aetna American Axle |
$0.39
|
| Rate for Payer: Aetna Commercial |
$0.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.39
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cofinity Commercial |
$0.42
|
| Rate for Payer: Cofinity Commercial |
$0.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.48
|
| Rate for Payer: Healthscope Commercial |
$0.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.51
|
| Rate for Payer: PHP Commercial |
$0.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.42
|
| Rate for Payer: Priority Health SBD |
$0.38
|
| Rate for Payer: UMR Bronson Commercial |
$0.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.45
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION
|
Facility
|
IP
|
$110.96
|
|
|
Service Code
|
NDC 48433-230-15
|
| Hospital Charge Code |
108150
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.82 |
| Max. Negotiated Rate |
$99.86 |
| Rate for Payer: Aetna American Axle |
$72.12
|
| Rate for Payer: Aetna Commercial |
$94.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.12
|
| Rate for Payer: Cash Price |
$88.77
|
| Rate for Payer: Cofinity Commercial |
$77.67
|
| Rate for Payer: Cofinity Commercial |
$95.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.77
|
| Rate for Payer: Healthscope Commercial |
$99.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.32
|
| Rate for Payer: PHP Commercial |
$94.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.67
|
| Rate for Payer: Priority Health SBD |
$69.90
|
| Rate for Payer: UMR Bronson Commercial |
$48.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.22
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION
|
Facility
|
IP
|
$411.28
|
|
|
Service Code
|
NDC 0395-2775-16
|
| Hospital Charge Code |
108150
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.96 |
| Max. Negotiated Rate |
$370.15 |
| Rate for Payer: Aetna American Axle |
$267.33
|
| Rate for Payer: Aetna Commercial |
$349.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.33
|
| Rate for Payer: Cash Price |
$329.02
|
| Rate for Payer: Cofinity Commercial |
$287.90
|
| Rate for Payer: Cofinity Commercial |
$353.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.02
|
| Rate for Payer: Healthscope Commercial |
$370.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$349.59
|
| Rate for Payer: PHP Commercial |
$349.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.90
|
| Rate for Payer: Priority Health SBD |
$259.11
|
| Rate for Payer: UMR Bronson Commercial |
$180.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.46
|
|
|
IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27.90
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
17595
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna American Axle |
$18.14
|
| Rate for Payer: Aetna American Axle |
$61.75
|
| Rate for Payer: Aetna American Axle |
$123.50
|
| Rate for Payer: Aetna Commercial |
$23.72
|
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.14
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$163.40
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Cofinity Commercial |
$133.00
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Cofinity Commercial |
$19.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Healthscope Commercial |
$171.00
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Healthscope Commercial |
$25.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.50
|
| Rate for Payer: PHP Commercial |
$23.72
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: PHP Commercial |
$161.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.53
|
| Rate for Payer: Priority Health SBD |
$59.85
|
| Rate for Payer: Priority Health SBD |
$17.58
|
| Rate for Payer: Priority Health SBD |
$119.70
|
| Rate for Payer: UMR Bronson Commercial |
$83.60
|
| Rate for Payer: UMR Bronson Commercial |
$12.28
|
| Rate for Payer: UMR Bronson Commercial |
$41.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.25
|
|
|
IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$116.11
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
10321
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.09 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Aetna American Axle |
$75.47
|
| Rate for Payer: Aetna Commercial |
$98.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.47
|
| Rate for Payer: Cash Price |
$92.89
|
| Rate for Payer: Cofinity Commercial |
$99.85
|
| Rate for Payer: Cofinity Commercial |
$81.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.89
|
| Rate for Payer: Healthscope Commercial |
$104.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.69
|
| Rate for Payer: PHP Commercial |
$98.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.28
|
| Rate for Payer: Priority Health SBD |
$73.15
|
| Rate for Payer: UMR Bronson Commercial |
$51.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.08
|
|
|
IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna American Axle |
$87.75
|
| Rate for Payer: Aetna American Axle |
$16.96
|
| Rate for Payer: Aetna American Axle |
$43.88
|
| Rate for Payer: Aetna Commercial |
$22.18
|
| Rate for Payer: Aetna Commercial |
$114.75
|
| Rate for Payer: Aetna Commercial |
$57.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.75
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Cofinity Commercial |
$116.10
|
| Rate for Payer: Cofinity Commercial |
$94.50
|
| Rate for Payer: Cofinity Commercial |
$22.45
|
| Rate for Payer: Cofinity Commercial |
$47.25
|
| Rate for Payer: Cofinity Commercial |
$58.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.88
|
| Rate for Payer: Healthscope Commercial |
$121.50
|
| Rate for Payer: Healthscope Commercial |
$60.75
|
| Rate for Payer: Healthscope Commercial |
$23.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.18
|
| Rate for Payer: PHP Commercial |
$114.75
|
| Rate for Payer: PHP Commercial |
$22.18
|
| Rate for Payer: PHP Commercial |
$57.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.50
|
| Rate for Payer: Priority Health SBD |
$16.44
|
| Rate for Payer: Priority Health SBD |
$42.52
|
| Rate for Payer: Priority Health SBD |
$85.05
|
| Rate for Payer: UMR Bronson Commercial |
$11.48
|
| Rate for Payer: UMR Bronson Commercial |
$59.40
|
| Rate for Payer: UMR Bronson Commercial |
$29.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.58
|
|
|
IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,016.25
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$447.15 |
| Max. Negotiated Rate |
$914.62 |
| Rate for Payer: Aetna American Axle |
$660.56
|
| Rate for Payer: Aetna Commercial |
$863.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.56
|
| Rate for Payer: Cash Price |
$813.00
|
| Rate for Payer: Cofinity Commercial |
$711.38
|
| Rate for Payer: Cofinity Commercial |
$873.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.00
|
| Rate for Payer: Healthscope Commercial |
$914.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$711.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$762.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$863.81
|
| Rate for Payer: PHP Commercial |
$863.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$711.38
|
| Rate for Payer: Priority Health SBD |
$640.24
|
| Rate for Payer: UMR Bronson Commercial |
$447.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$762.19
|
|
|
IOPAMIDOL 200 MG IODINE/ML (41 %) INTRATHECAL SOLUTION
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
10325
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna American Axle |
$29.90
|
| Rate for Payer: Aetna Commercial |
$39.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.90
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Commercial |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$39.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Healthscope Commercial |
$41.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.10
|
| Rate for Payer: PHP Commercial |
$39.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.20
|
| Rate for Payer: Priority Health SBD |
$28.98
|
| Rate for Payer: UMR Bronson Commercial |
$20.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.50
|
|
|
IOPAMIDOL 300 MG IODINE/ML (61 %) INTRATHECAL SOLUTION
|
Facility
|
IP
|
$1.99
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Aetna American Axle |
$1.29
|
| Rate for Payer: Aetna American Axle |
$47.38
|
| Rate for Payer: Aetna Commercial |
$61.96
|
| Rate for Payer: Aetna Commercial |
$1.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.38
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cash Price |
$58.32
|
| Rate for Payer: Cofinity Commercial |
$1.71
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$51.03
|
| Rate for Payer: Cofinity Commercial |
$62.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.32
|
| Rate for Payer: Healthscope Commercial |
$65.61
|
| Rate for Payer: Healthscope Commercial |
$1.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.69
|
| Rate for Payer: PHP Commercial |
$1.69
|
| Rate for Payer: PHP Commercial |
$61.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.03
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: Priority Health SBD |
$45.93
|
| Rate for Payer: UMR Bronson Commercial |
$32.08
|
| Rate for Payer: UMR Bronson Commercial |
$0.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.49
|
|
