|
LORAZEPAM 2 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$17.86
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
112180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$17.86 |
| Rate for Payer: Aetna Commercial |
$16.07
|
| Rate for Payer: ASR ASR |
$17.32
|
| Rate for Payer: BCBS Trust/PPO |
$14.66
|
| Rate for Payer: BCN Commercial |
$14.66
|
| Rate for Payer: Cash Price |
$14.29
|
| Rate for Payer: Cofinity Commercial |
$16.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.29
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Whirlpool |
$17.86
|
| Rate for Payer: Mclaren Commercial |
$16.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.18
|
| Rate for Payer: Nomi Health Commercial |
$14.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.71
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$308.75
|
|
|
Service Code
|
NDC 904704761
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.24 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Aetna Commercial |
$277.88
|
| Rate for Payer: Aetna Medicare |
$114.24
|
| Rate for Payer: ASR ASR |
$299.49
|
| Rate for Payer: BCBS Complete |
$123.50
|
| Rate for Payer: BCBS Trust/PPO |
$254.56
|
| Rate for Payer: BCN Commercial |
$254.56
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cofinity Commercial |
$290.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.00
|
| Rate for Payer: Healthscope Commercial |
$299.49
|
| Rate for Payer: Healthscope Whirlpool |
$308.75
|
| Rate for Payer: Mclaren Commercial |
$277.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.44
|
| Rate for Payer: Nomi Health Commercial |
$253.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$270.53
|
| Rate for Payer: Priority Health Narrow Network |
$216.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.70
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$308.75
|
|
|
Service Code
|
NDC 904704761
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.56 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Aetna Commercial |
$277.88
|
| Rate for Payer: ASR ASR |
$299.49
|
| Rate for Payer: BCBS Trust/PPO |
$253.55
|
| Rate for Payer: BCN Commercial |
$253.55
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cofinity Commercial |
$290.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.00
|
| Rate for Payer: Healthscope Commercial |
$299.49
|
| Rate for Payer: Healthscope Whirlpool |
$308.75
|
| Rate for Payer: Mclaren Commercial |
$277.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.44
|
| Rate for Payer: Nomi Health Commercial |
$253.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.70
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$259.35
|
|
|
Service Code
|
NDC 68084034711
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.96 |
| Max. Negotiated Rate |
$259.35 |
| Rate for Payer: Aetna Commercial |
$233.41
|
| Rate for Payer: Aetna Medicare |
$95.96
|
| Rate for Payer: ASR ASR |
$251.57
|
| Rate for Payer: BCBS Complete |
$103.74
|
| Rate for Payer: BCBS Trust/PPO |
$213.83
|
| Rate for Payer: BCN Commercial |
$213.83
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cofinity Commercial |
$243.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.48
|
| Rate for Payer: Healthscope Commercial |
$251.57
|
| Rate for Payer: Healthscope Whirlpool |
$259.35
|
| Rate for Payer: Mclaren Commercial |
$233.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.45
|
| Rate for Payer: Nomi Health Commercial |
$212.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$227.24
|
| Rate for Payer: Priority Health Narrow Network |
$181.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.23
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$259.35
|
|
|
Service Code
|
NDC 68084034711
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.51 |
| Max. Negotiated Rate |
$259.35 |
| Rate for Payer: Aetna Commercial |
$233.41
|
| Rate for Payer: ASR ASR |
$251.57
|
| Rate for Payer: BCBS Trust/PPO |
$212.98
|
| Rate for Payer: BCN Commercial |
$212.98
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cofinity Commercial |
$243.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.48
|
| Rate for Payer: Healthscope Commercial |
$251.57
|
| Rate for Payer: Healthscope Whirlpool |
$259.35
|
| Rate for Payer: Mclaren Commercial |
$233.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.45
|
| Rate for Payer: Nomi Health Commercial |
$212.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.23
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$235.60
|
|
|
Service Code
|
NDC 904704861
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.70 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Aetna Commercial |
$212.04
|
| Rate for Payer: ASR ASR |
$228.53
|
| Rate for Payer: BCBS Trust/PPO |
$193.47
|
| Rate for Payer: BCN Commercial |
$193.47
|
| Rate for Payer: Cash Price |
$188.48
|
| Rate for Payer: Cofinity Commercial |
$221.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.48
|
| Rate for Payer: Healthscope Commercial |
$228.53
|
| Rate for Payer: Healthscope Whirlpool |
$235.60
|
| Rate for Payer: Mclaren Commercial |
$212.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.26
|
| Rate for Payer: Nomi Health Commercial |
$193.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.33
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$235.60
|
|
|
Service Code
|
NDC 904704861
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.17 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Aetna Commercial |
$212.04
|
| Rate for Payer: Aetna Medicare |
$87.17
|
| Rate for Payer: ASR ASR |
$228.53
|
| Rate for Payer: BCBS Complete |
$94.24
|
| Rate for Payer: BCBS Trust/PPO |
$194.25
|
| Rate for Payer: BCN Commercial |
$194.25
|
| Rate for Payer: Cash Price |
$188.48
|
| Rate for Payer: Cofinity Commercial |
$221.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.48
|
| Rate for Payer: Healthscope Commercial |
$228.53
|
| Rate for Payer: Healthscope Whirlpool |
$235.60
|
| Rate for Payer: Mclaren Commercial |
$212.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.26
|
| Rate for Payer: Nomi Health Commercial |
$193.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$206.43
|
| Rate for Payer: Priority Health Narrow Network |
$165.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.33
|
|
|
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC
|
Facility
|
IP
|
$34,842.97
|
|
|
Service Code
|
MSDRG 493
|
| Min. Negotiated Rate |
$19,016.65 |
| Max. Negotiated Rate |
$34,842.97 |
| Rate for Payer: Aetna Medicare |
$20,017.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,021.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,021.91
|
| Rate for Payer: BCBS MAPPO |
$20,017.53
|
| Rate for Payer: BCN Medicare Advantage |
$20,017.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,017.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$20,017.53
|
| Rate for Payer: Mclaren Medicare |
$20,017.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,018.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,020.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,019.28
|
| Rate for Payer: PACE Medicare |
$19,016.65
|
| Rate for Payer: PACE SWMI |
$20,017.53
|
| Rate for Payer: PHP Commercial |
$22,019.28
|
| Rate for Payer: PHP Medicare Advantage |
$20,017.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34,842.97
|
| Rate for Payer: Priority Health Medicare |
$20,017.53
|
| Rate for Payer: Priority Health Narrow Network |
$27,874.38
|
| Rate for Payer: Railroad Medicare Medicare |
$20,017.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,017.53
|
| Rate for Payer: UHC Exchange |
$31,027.17
|
| Rate for Payer: UHCCP DNSP |
$20,017.53
|
| Rate for Payer: VA VA |
$20,017.53
|
|
|
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC
|
Facility
|
IP
|
$50,443.38
|
|
|
Service Code
|
MSDRG 492
|
| Min. Negotiated Rate |
$26,784.81 |
| Max. Negotiated Rate |
$50,443.38 |
| Rate for Payer: Aetna Medicare |
$28,194.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,243.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,243.18
|
| Rate for Payer: BCBS MAPPO |
$28,194.54
|
| Rate for Payer: BCN Medicare Advantage |
$28,194.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,194.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$28,194.54
|
| Rate for Payer: Mclaren Medicare |
$28,194.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,604.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,423.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$31,013.99
|
| Rate for Payer: PACE Medicare |
$26,784.81
|
| Rate for Payer: PACE SWMI |
$28,194.54
|
| Rate for Payer: PHP Commercial |
$31,013.99
|
| Rate for Payer: PHP Medicare Advantage |
$28,194.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$50,443.38
|
| Rate for Payer: Priority Health Medicare |
$28,194.54
|
| Rate for Payer: Priority Health Narrow Network |
$40,354.70
|
| Rate for Payer: Railroad Medicare Medicare |
$28,194.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28,194.54
|
| Rate for Payer: UHC Exchange |
$43,701.54
|
| Rate for Payer: UHCCP DNSP |
$28,194.54
|
| Rate for Payer: VA VA |
$28,194.54
|
|
|
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC
|
Facility
|
IP
|
$27,566.90
|
|
|
Service Code
|
MSDRG 494
|
| Min. Negotiated Rate |
$15,393.56 |
| Max. Negotiated Rate |
$27,566.90 |
| Rate for Payer: Aetna Medicare |
$16,203.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,254.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,254.69
|
| Rate for Payer: BCBS MAPPO |
$16,203.75
|
| Rate for Payer: BCN Medicare Advantage |
$16,203.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,203.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,203.75
|
| Rate for Payer: Mclaren Medicare |
$16,203.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,013.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,634.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,824.12
|
| Rate for Payer: PACE Medicare |
$15,393.56
|
| Rate for Payer: PACE SWMI |
$16,203.75
|
| Rate for Payer: PHP Commercial |
$17,824.12
|
| Rate for Payer: PHP Medicare Advantage |
$16,203.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27,566.90
|
| Rate for Payer: Priority Health Medicare |
$16,203.75
|
| Rate for Payer: Priority Health Narrow Network |
$22,053.52
|
| Rate for Payer: Railroad Medicare Medicare |
$16,203.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,203.75
|
| Rate for Payer: UHC Exchange |
$25,115.81
|
| Rate for Payer: UHCCP DNSP |
$16,203.75
|
| Rate for Payer: VA VA |
$16,203.75
|
|
|
LOWER VASCULAR PROCEDURES
|
Facility
|
IP
|
$18,820.94
|
|
|
Service Code
|
APR-DRG 1813
|
| Min. Negotiated Rate |
$17,016.38 |
| Max. Negotiated Rate |
$18,820.94 |
| Rate for Payer: BCBS Complete |
$18,820.94
|
| Rate for Payer: Mclaren Medicaid |
$17,924.70
|
| Rate for Payer: Meridian Medicaid |
$18,820.94
|
| Rate for Payer: PHP Medicaid |
$17,016.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,924.70
|
| Rate for Payer: UHC Medicaid |
$17,924.70
|
| Rate for Payer: UHCCP Medicaid |
$17,924.70
|
|
|
LOWER VASCULAR PROCEDURES
|
Facility
|
IP
|
$13,788.32
|
|
|
Service Code
|
APR-DRG 1812
|
| Min. Negotiated Rate |
$12,466.30 |
| Max. Negotiated Rate |
$13,788.32 |
| Rate for Payer: BCBS Complete |
$13,788.32
|
| Rate for Payer: Mclaren Medicaid |
$13,131.74
|
| Rate for Payer: Meridian Medicaid |
$13,788.32
|
| Rate for Payer: PHP Medicaid |
$12,466.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,131.74
|
| Rate for Payer: UHC Medicaid |
$13,131.74
|
| Rate for Payer: UHCCP Medicaid |
$13,131.74
|
|
|
LOWER VASCULAR PROCEDURES
|
Facility
|
IP
|
$27,676.38
|
|
|
Service Code
|
APR-DRG 1814
|
| Min. Negotiated Rate |
$25,022.75 |
| Max. Negotiated Rate |
$27,676.38 |
| Rate for Payer: BCBS Complete |
$27,676.38
|
| Rate for Payer: Mclaren Medicaid |
$26,358.45
|
| Rate for Payer: Meridian Medicaid |
$27,676.38
|
| Rate for Payer: PHP Medicaid |
$25,022.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$26,358.45
|
| Rate for Payer: UHC Medicaid |
$26,358.45
|
| Rate for Payer: UHCCP Medicaid |
$26,358.45
|
|
|
LOWER VASCULAR PROCEDURES
|
Facility
|
IP
|
$9,434.72
|
|
|
Service Code
|
APR-DRG 1811
|
| Min. Negotiated Rate |
$8,530.12 |
| Max. Negotiated Rate |
$9,434.72 |
| Rate for Payer: BCBS Complete |
$9,434.72
|
| Rate for Payer: Mclaren Medicaid |
$8,985.45
|
| Rate for Payer: Meridian Medicaid |
$9,434.72
|
| Rate for Payer: PHP Medicaid |
$8,530.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,985.45
|
| Rate for Payer: UHC Medicaid |
$8,985.45
|
| Rate for Payer: UHCCP Medicaid |
$8,985.45
|
|
|
LUNG TRANSPLANT
|
Facility
|
IP
|
$177,920.21
|
|
|
Service Code
|
MSDRG 007
|
| Min. Negotiated Rate |
$90,261.41 |
| Max. Negotiated Rate |
$177,920.21 |
| Rate for Payer: Aetna Medicare |
$95,012.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118,765.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118,765.01
|
| Rate for Payer: BCBS MAPPO |
$95,012.01
|
| Rate for Payer: BCN Medicare Advantage |
$95,012.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95,012.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$95,012.01
|
| Rate for Payer: Mclaren Medicare |
$95,012.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99,762.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109,263.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$104,513.21
|
| Rate for Payer: PACE Medicare |
$90,261.41
|
| Rate for Payer: PACE SWMI |
$95,012.01
|
| Rate for Payer: PHP Commercial |
$104,513.21
|
| Rate for Payer: PHP Medicare Advantage |
$95,012.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$177,920.21
|
| Rate for Payer: Priority Health Medicare |
$95,012.01
|
| Rate for Payer: Priority Health Narrow Network |
$142,336.17
|
| Rate for Payer: Railroad Medicare Medicare |
$95,012.01
|
| Rate for Payer: UHCCP DNSP |
$95,012.01
|
| Rate for Payer: VA VA |
$95,012.01
|
|
|
LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$18,202.00
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$18,202.00 |
| Rate for Payer: Aetna Commercial |
$16,381.80
|
| Rate for Payer: Aetna Medicare |
$42.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.44
|
| Rate for Payer: ASR ASR |
$17,655.94
|
| Rate for Payer: BCBS Complete |
$23.48
|
| Rate for Payer: BCBS MAPPO |
$42.75
|
| Rate for Payer: BCBS Trust/PPO |
$15,007.55
|
| Rate for Payer: BCN Commercial |
$15,007.55
|
| Rate for Payer: BCN Medicare Advantage |
$42.75
|
| Rate for Payer: Cash Price |
$14,561.60
|
| Rate for Payer: Cash Price |
$14,561.60
|
| Rate for Payer: Cofinity Commercial |
$17,109.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,561.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.75
|
| Rate for Payer: Healthscope Commercial |
$17,655.94
|
| Rate for Payer: Healthscope Whirlpool |
$18,202.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.75
|
| Rate for Payer: Mclaren Commercial |
$16,381.80
|
| Rate for Payer: Mclaren Medicaid |
$42.75
|
| Rate for Payer: Mclaren Medicare |
$42.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.89
|
| Rate for Payer: Meridian Medicaid |
$23.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,471.70
|
| Rate for Payer: Nomi Health Commercial |
$14,925.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,651.50
|
| Rate for Payer: PACE Medicare |
$40.61
|
| Rate for Payer: PACE SWMI |
$42.75
|
| Rate for Payer: PHP Commercial |
$47.02
|
| Rate for Payer: PHP Medicaid |
$22.91
|
| Rate for Payer: PHP Medicare Advantage |
$42.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44.39
|
| Rate for Payer: Priority Health Medicare |
$42.75
|
| Rate for Payer: Priority Health Narrow Network |
$35.51
|
| Rate for Payer: Railroad Medicare Medicare |
$42.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,017.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.75
|
| Rate for Payer: UHC Exchange |
$66.26
|
| Rate for Payer: UHC Medicaid |
$22.36
|
| Rate for Payer: UHCCP DNSP |
$42.75
|
| Rate for Payer: UHCCP Medicaid |
$22.36
|
| Rate for Payer: VA VA |
$42.75
|
|
|
LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$18,202.00
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,651.50 |
| Max. Negotiated Rate |
$18,202.00 |
| Rate for Payer: Aetna Commercial |
$16,381.80
|
| Rate for Payer: ASR ASR |
$17,655.94
|
| Rate for Payer: BCBS Trust/PPO |
$14,947.48
|
| Rate for Payer: BCN Commercial |
$14,947.48
|
| Rate for Payer: Cash Price |
$14,561.60
|
| Rate for Payer: Cofinity Commercial |
$17,109.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,561.60
|
| Rate for Payer: Healthscope Commercial |
$17,655.94
|
| Rate for Payer: Healthscope Whirlpool |
$18,202.00
|
| Rate for Payer: Mclaren Commercial |
$16,381.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,471.70
|
| Rate for Payer: Nomi Health Commercial |
$14,925.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,651.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,017.76
|
|
|
LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$54,605.00
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40,953.75 |
| Max. Negotiated Rate |
$54,605.00 |
| Rate for Payer: Aetna Commercial |
$49,144.50
|
| Rate for Payer: ASR ASR |
$52,966.85
|
| Rate for Payer: BCBS Trust/PPO |
$44,841.63
|
| Rate for Payer: BCN Commercial |
$44,841.63
|
| Rate for Payer: Cash Price |
$43,684.00
|
| Rate for Payer: Cofinity Commercial |
$51,328.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43,684.00
|
| Rate for Payer: Healthscope Commercial |
$52,966.85
|
| Rate for Payer: Healthscope Whirlpool |
$54,605.00
|
| Rate for Payer: Mclaren Commercial |
$49,144.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46,414.25
|
| Rate for Payer: Nomi Health Commercial |
$44,776.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40,953.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48,052.40
|
|
|
LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$54,605.00
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$54,605.00 |
| Rate for Payer: Aetna Commercial |
$49,144.50
|
| Rate for Payer: Aetna Medicare |
$42.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.44
|
| Rate for Payer: ASR ASR |
$52,966.85
|
| Rate for Payer: BCBS Complete |
$23.48
|
| Rate for Payer: BCBS MAPPO |
$42.75
|
| Rate for Payer: BCBS Trust/PPO |
$45,021.82
|
| Rate for Payer: BCN Commercial |
$45,021.82
|
| Rate for Payer: BCN Medicare Advantage |
$42.75
|
| Rate for Payer: Cash Price |
$43,684.00
|
| Rate for Payer: Cash Price |
$43,684.00
|
| Rate for Payer: Cofinity Commercial |
$51,328.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43,684.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.75
|
| Rate for Payer: Healthscope Commercial |
$52,966.85
|
| Rate for Payer: Healthscope Whirlpool |
$54,605.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.75
|
| Rate for Payer: Mclaren Commercial |
$49,144.50
|
| Rate for Payer: Mclaren Medicaid |
$42.75
|
| Rate for Payer: Mclaren Medicare |
$42.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.89
|
| Rate for Payer: Meridian Medicaid |
$23.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46,414.25
|
| Rate for Payer: Nomi Health Commercial |
$44,776.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40,953.75
|
| Rate for Payer: PACE Medicare |
$40.61
|
| Rate for Payer: PACE SWMI |
$42.75
|
| Rate for Payer: PHP Commercial |
$47.02
|
| Rate for Payer: PHP Medicaid |
$22.91
|
| Rate for Payer: PHP Medicare Advantage |
$42.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44.39
|
| Rate for Payer: Priority Health Medicare |
$42.75
|
| Rate for Payer: Priority Health Narrow Network |
$35.51
|
| Rate for Payer: Railroad Medicare Medicare |
$42.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48,052.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.75
|
| Rate for Payer: UHC Exchange |
$66.26
|
| Rate for Payer: UHC Medicaid |
$22.36
|
| Rate for Payer: UHCCP DNSP |
$42.75
|
| Rate for Payer: UHCCP Medicaid |
$22.36
|
| Rate for Payer: VA VA |
$42.75
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$6,033.14
|
|
|
Service Code
|
APR-DRG 6942
|
| Min. Negotiated Rate |
$5,454.68 |
| Max. Negotiated Rate |
$6,033.14 |
| Rate for Payer: BCBS Complete |
$6,033.14
|
| Rate for Payer: Mclaren Medicaid |
$5,745.85
|
| Rate for Payer: Meridian Medicaid |
$6,033.14
|
| Rate for Payer: PHP Medicaid |
$5,454.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,745.85
|
| Rate for Payer: UHC Medicaid |
$5,745.85
|
| Rate for Payer: UHCCP Medicaid |
$5,745.85
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$4,153.06
|
|
|
Service Code
|
APR-DRG 6941
|
| Min. Negotiated Rate |
$3,754.87 |
| Max. Negotiated Rate |
$4,153.06 |
| Rate for Payer: BCBS Complete |
$4,153.06
|
| Rate for Payer: Mclaren Medicaid |
$3,955.30
|
| Rate for Payer: Meridian Medicaid |
$4,153.06
|
| Rate for Payer: PHP Medicaid |
$3,754.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,955.30
|
| Rate for Payer: UHC Medicaid |
$3,955.30
|
| Rate for Payer: UHCCP Medicaid |
$3,955.30
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$11,172.56
|
|
|
Service Code
|
APR-DRG 6944
|
| Min. Negotiated Rate |
$10,101.34 |
| Max. Negotiated Rate |
$11,172.56 |
| Rate for Payer: BCBS Complete |
$11,172.56
|
| Rate for Payer: Mclaren Medicaid |
$10,640.54
|
| Rate for Payer: Meridian Medicaid |
$11,172.56
|
| Rate for Payer: PHP Medicaid |
$10,101.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,640.54
|
| Rate for Payer: UHC Medicaid |
$10,640.54
|
| Rate for Payer: UHCCP Medicaid |
$10,640.54
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$7,560.64
|
|
|
Service Code
|
APR-DRG 6943
|
| Min. Negotiated Rate |
$6,835.72 |
| Max. Negotiated Rate |
$7,560.64 |
| Rate for Payer: BCBS Complete |
$7,560.64
|
| Rate for Payer: Mclaren Medicaid |
$7,200.61
|
| Rate for Payer: Meridian Medicaid |
$7,560.64
|
| Rate for Payer: PHP Medicaid |
$6,835.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,200.61
|
| Rate for Payer: UHC Medicaid |
$7,200.61
|
| Rate for Payer: UHCCP Medicaid |
$7,200.61
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$30,755.68
|
|
|
Service Code
|
MSDRG 821
|
| Min. Negotiated Rate |
$16,981.40 |
| Max. Negotiated Rate |
$30,755.68 |
| Rate for Payer: Aetna Medicare |
$17,875.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,343.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,343.95
|
| Rate for Payer: BCBS MAPPO |
$17,875.16
|
| Rate for Payer: BCN Medicare Advantage |
$17,875.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,875.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,875.16
|
| Rate for Payer: Mclaren Medicare |
$17,875.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,768.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,556.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,662.68
|
| Rate for Payer: PACE Medicare |
$16,981.40
|
| Rate for Payer: PACE SWMI |
$17,875.16
|
| Rate for Payer: PHP Commercial |
$19,662.68
|
| Rate for Payer: PHP Medicare Advantage |
$17,875.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30,755.68
|
| Rate for Payer: Priority Health Medicare |
$17,875.16
|
| Rate for Payer: Priority Health Narrow Network |
$24,604.54
|
| Rate for Payer: Railroad Medicare Medicare |
$17,875.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,875.16
|
| Rate for Payer: UHC Exchange |
$27,706.50
|
| Rate for Payer: UHCCP DNSP |
$17,875.16
|
| Rate for Payer: VA VA |
$17,875.16
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$80,575.31
|
|
|
Service Code
|
MSDRG 820
|
| Min. Negotiated Rate |
$41,788.90 |
| Max. Negotiated Rate |
$80,575.31 |
| Rate for Payer: Aetna Medicare |
$43,988.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54,985.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54,985.40
|
| Rate for Payer: BCBS MAPPO |
$43,988.32
|
| Rate for Payer: BCN Medicare Advantage |
$43,988.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43,988.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$43,988.32
|
| Rate for Payer: Mclaren Medicare |
$43,988.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46,187.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50,586.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$48,387.15
|
| Rate for Payer: PACE Medicare |
$41,788.90
|
| Rate for Payer: PACE SWMI |
$43,988.32
|
| Rate for Payer: PHP Commercial |
$48,387.15
|
| Rate for Payer: PHP Medicare Advantage |
$43,988.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$80,575.31
|
| Rate for Payer: Priority Health Medicare |
$43,988.32
|
| Rate for Payer: Priority Health Narrow Network |
$64,460.25
|
| Rate for Payer: Railroad Medicare Medicare |
$43,988.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$43,988.32
|
| Rate for Payer: UHC Exchange |
$68,181.90
|
| Rate for Payer: UHCCP DNSP |
$43,988.32
|
| Rate for Payer: VA VA |
$43,988.32
|
|
