|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS
|
Facility
|
IP
|
$13,702.77
|
|
|
Service Code
|
APR-DRG 1301
|
| Min. Negotiated Rate |
$12,388.94 |
| Max. Negotiated Rate |
$13,702.77 |
| Rate for Payer: BCBS Complete |
$13,702.77
|
| Rate for Payer: Mclaren Medicaid |
$13,050.25
|
| Rate for Payer: Meridian Medicaid |
$13,702.77
|
| Rate for Payer: PHP Medicaid |
$12,388.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,050.25
|
| Rate for Payer: UHC Medicaid |
$13,050.25
|
| Rate for Payer: UHCCP Medicaid |
$13,050.25
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS
|
Facility
|
IP
|
$23,635.57
|
|
|
Service Code
|
APR-DRG 1303
|
| Min. Negotiated Rate |
$21,369.38 |
| Max. Negotiated Rate |
$23,635.57 |
| Rate for Payer: BCBS Complete |
$23,635.57
|
| Rate for Payer: Mclaren Medicaid |
$22,510.07
|
| Rate for Payer: Meridian Medicaid |
$23,635.57
|
| Rate for Payer: PHP Medicaid |
$21,369.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,510.07
|
| Rate for Payer: UHC Medicaid |
$22,510.07
|
| Rate for Payer: UHCCP Medicaid |
$22,510.07
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS
|
Facility
|
IP
|
$26,388.11
|
|
|
Service Code
|
APR-DRG 1304
|
| Min. Negotiated Rate |
$23,858.01 |
| Max. Negotiated Rate |
$26,388.11 |
| Rate for Payer: BCBS Complete |
$26,388.11
|
| Rate for Payer: Mclaren Medicaid |
$25,131.54
|
| Rate for Payer: Meridian Medicaid |
$26,388.11
|
| Rate for Payer: PHP Medicaid |
$23,858.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$25,131.54
|
| Rate for Payer: UHC Medicaid |
$25,131.54
|
| Rate for Payer: UHCCP Medicaid |
$25,131.54
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS
|
Facility
|
IP
|
$17,436.77
|
|
|
Service Code
|
APR-DRG 1302
|
| Min. Negotiated Rate |
$15,764.92 |
| Max. Negotiated Rate |
$17,436.77 |
| Rate for Payer: BCBS Complete |
$17,436.77
|
| Rate for Payer: Mclaren Medicaid |
$16,606.44
|
| Rate for Payer: Meridian Medicaid |
$17,436.77
|
| Rate for Payer: PHP Medicaid |
$15,764.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,606.44
|
| Rate for Payer: UHC Medicaid |
$16,606.44
|
| Rate for Payer: UHCCP Medicaid |
$16,606.44
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS
|
Facility
|
IP
|
$88,405.06
|
|
|
Service Code
|
MSDRG 207
|
| Min. Negotiated Rate |
$45,687.69 |
| Max. Negotiated Rate |
$88,405.06 |
| Rate for Payer: Aetna Medicare |
$48,092.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60,115.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60,115.39
|
| Rate for Payer: BCBS MAPPO |
$48,092.31
|
| Rate for Payer: BCN Medicare Advantage |
$48,092.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48,092.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$48,092.31
|
| Rate for Payer: Mclaren Medicare |
$48,092.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50,496.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55,306.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$52,901.54
|
| Rate for Payer: PACE Medicare |
$45,687.69
|
| Rate for Payer: PACE SWMI |
$48,092.31
|
| Rate for Payer: PHP Commercial |
$52,901.54
|
| Rate for Payer: PHP Medicare Advantage |
$48,092.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$88,405.06
|
| Rate for Payer: Priority Health Medicare |
$48,092.31
|
| Rate for Payer: Priority Health Narrow Network |
$70,724.05
|
| Rate for Payer: Railroad Medicare Medicare |
$48,092.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$48,092.31
|
| Rate for Payer: UHC Exchange |
$74,543.08
|
| Rate for Payer: UHCCP DNSP |
$48,092.31
|
| Rate for Payer: VA VA |
$48,092.31
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC
|
Facility
|
IP
|
$14,037.61
|
|
|
Service Code
|
MSDRG 815
|
| Min. Negotiated Rate |
$8,603.69 |
| Max. Negotiated Rate |
$14,037.61 |
| Rate for Payer: Aetna Medicare |
$9,056.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,320.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,320.65
|
| Rate for Payer: BCBS MAPPO |
$9,056.52
|
| Rate for Payer: BCN Medicare Advantage |
$9,056.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,056.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,056.52
|
| Rate for Payer: Mclaren Medicare |
$9,056.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,509.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,415.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,962.17
|
| Rate for Payer: PACE Medicare |
$8,603.69
|
| Rate for Payer: PACE SWMI |
$9,056.52
|
| Rate for Payer: PHP Commercial |
$9,962.17
|
| Rate for Payer: PHP Medicare Advantage |
$9,056.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13,931.14
|
| Rate for Payer: Priority Health Medicare |
$9,056.52
|
| Rate for Payer: Priority Health Narrow Network |
$11,144.91
|
| Rate for Payer: Railroad Medicare Medicare |
$9,056.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,056.52
|
| Rate for Payer: UHC Exchange |
$14,037.61
|
| Rate for Payer: UHCCP DNSP |
$9,056.52
|
| Rate for Payer: VA VA |
$9,056.52
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC
|
Facility
|
IP
|
$29,218.31
|
|
|
Service Code
|
MSDRG 814
|
| Min. Negotiated Rate |
$16,215.87 |
| Max. Negotiated Rate |
$29,218.31 |
| Rate for Payer: Aetna Medicare |
$17,069.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,336.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,336.67
|
| Rate for Payer: BCBS MAPPO |
$17,069.34
|
| Rate for Payer: BCN Medicare Advantage |
$17,069.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,069.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,069.34
|
| Rate for Payer: Mclaren Medicare |
$17,069.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,922.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,629.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,776.27
|
| Rate for Payer: PACE Medicare |
$16,215.87
|
| Rate for Payer: PACE SWMI |
$17,069.34
|
| Rate for Payer: PHP Commercial |
$18,776.27
|
| Rate for Payer: PHP Medicare Advantage |
$17,069.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29,218.31
|
| Rate for Payer: Priority Health Medicare |
$17,069.34
|
| Rate for Payer: Priority Health Narrow Network |
$23,374.64
|
| Rate for Payer: Railroad Medicare Medicare |
$17,069.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,069.34
|
| Rate for Payer: UHC Exchange |
$26,457.48
|
| Rate for Payer: UHCCP DNSP |
$17,069.34
|
| Rate for Payer: VA VA |
$17,069.34
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,773.76
|
|
|
Service Code
|
MSDRG 816
|
| Min. Negotiated Rate |
$5,990.37 |
| Max. Negotiated Rate |
$9,773.76 |
| Rate for Payer: Aetna Medicare |
$6,305.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,882.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,882.06
|
| Rate for Payer: BCBS MAPPO |
$6,305.65
|
| Rate for Payer: BCN Medicare Advantage |
$6,305.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,305.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,305.65
|
| Rate for Payer: Mclaren Medicare |
$6,305.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,620.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,251.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,936.22
|
| Rate for Payer: PACE Medicare |
$5,990.37
|
| Rate for Payer: PACE SWMI |
$6,305.65
|
| Rate for Payer: PHP Commercial |
$6,936.22
|
| Rate for Payer: PHP Medicare Advantage |
$6,305.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8,682.92
|
| Rate for Payer: Priority Health Medicare |
$6,305.65
|
| Rate for Payer: Priority Health Narrow Network |
$6,946.34
|
| Rate for Payer: Railroad Medicare Medicare |
$6,305.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,305.65
|
| Rate for Payer: UHC Exchange |
$9,773.76
|
| Rate for Payer: UHCCP DNSP |
$6,305.65
|
| Rate for Payer: VA VA |
$6,305.65
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITH CC
|
Facility
|
IP
|
$48,451.25
|
|
|
Service Code
|
MSDRG 467
|
| Min. Negotiated Rate |
$25,792.85 |
| Max. Negotiated Rate |
$48,451.25 |
| Rate for Payer: Aetna Medicare |
$27,150.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,937.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,937.96
|
| Rate for Payer: BCBS MAPPO |
$27,150.37
|
| Rate for Payer: BCN Medicare Advantage |
$27,150.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,150.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$27,150.37
|
| Rate for Payer: Mclaren Medicare |
$27,150.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28,507.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,222.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$29,865.41
|
| Rate for Payer: PACE Medicare |
$25,792.85
|
| Rate for Payer: PACE SWMI |
$27,150.37
|
| Rate for Payer: PHP Commercial |
$29,865.41
|
| Rate for Payer: PHP Medicare Advantage |
$27,150.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$48,451.25
|
| Rate for Payer: Priority Health Medicare |
$27,150.37
|
| Rate for Payer: Priority Health Narrow Network |
$38,761.00
|
| Rate for Payer: Railroad Medicare Medicare |
$27,150.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27,150.37
|
| Rate for Payer: UHC Exchange |
$42,083.07
|
| Rate for Payer: UHCCP DNSP |
$27,150.37
|
| Rate for Payer: VA VA |
$27,150.37
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC
|
Facility
|
IP
|
$71,515.95
|
|
|
Service Code
|
MSDRG 466
|
| Min. Negotiated Rate |
$37,277.82 |
| Max. Negotiated Rate |
$71,515.95 |
| Rate for Payer: Aetna Medicare |
$39,239.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49,049.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49,049.76
|
| Rate for Payer: BCBS MAPPO |
$39,239.81
|
| Rate for Payer: BCN Medicare Advantage |
$39,239.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39,239.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$39,239.81
|
| Rate for Payer: Mclaren Medicare |
$39,239.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41,201.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45,125.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$43,163.79
|
| Rate for Payer: PACE Medicare |
$37,277.82
|
| Rate for Payer: PACE SWMI |
$39,239.81
|
| Rate for Payer: PHP Commercial |
$43,163.79
|
| Rate for Payer: PHP Medicare Advantage |
$39,239.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$71,515.95
|
| Rate for Payer: Priority Health Medicare |
$39,239.81
|
| Rate for Payer: Priority Health Narrow Network |
$57,212.76
|
| Rate for Payer: Railroad Medicare Medicare |
$39,239.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$39,239.81
|
| Rate for Payer: UHC Exchange |
$60,821.71
|
| Rate for Payer: UHCCP DNSP |
$39,239.81
|
| Rate for Payer: VA VA |
$39,239.81
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$37,754.22
|
|
|
Service Code
|
MSDRG 468
|
| Min. Negotiated Rate |
$20,466.31 |
| Max. Negotiated Rate |
$37,754.22 |
| Rate for Payer: Aetna Medicare |
$21,543.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,929.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,929.35
|
| Rate for Payer: BCBS MAPPO |
$21,543.48
|
| Rate for Payer: BCN Medicare Advantage |
$21,543.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,543.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$21,543.48
|
| Rate for Payer: Mclaren Medicare |
$21,543.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,620.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,775.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$23,697.83
|
| Rate for Payer: PACE Medicare |
$20,466.31
|
| Rate for Payer: PACE SWMI |
$21,543.48
|
| Rate for Payer: PHP Commercial |
$23,697.83
|
| Rate for Payer: PHP Medicare Advantage |
$21,543.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37,754.22
|
| Rate for Payer: Priority Health Medicare |
$21,543.48
|
| Rate for Payer: Priority Health Narrow Network |
$30,203.38
|
| Rate for Payer: Railroad Medicare Medicare |
$21,543.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21,543.48
|
| Rate for Payer: UHC Exchange |
$33,392.39
|
| Rate for Payer: UHCCP DNSP |
$21,543.48
|
| Rate for Payer: VA VA |
$21,543.48
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$287.30
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
11283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.86 |
| Max. Negotiated Rate |
$287.30 |
| Rate for Payer: Aetna Commercial |
$258.57
|
| Rate for Payer: Aetna Commercial |
$218.19
|
| Rate for Payer: Aetna Commercial |
$258.56
|
| Rate for Payer: Aetna Commercial |
$218.18
|
| Rate for Payer: Aetna Medicare |
$89.70
|
| Rate for Payer: Aetna Medicare |
$106.30
|
| Rate for Payer: Aetna Medicare |
$106.30
|
| Rate for Payer: Aetna Medicare |
$89.70
|
| Rate for Payer: ASR ASR |
$278.67
|
| Rate for Payer: ASR ASR |
$235.16
|
| Rate for Payer: ASR ASR |
$235.15
|
| Rate for Payer: ASR ASR |
$278.68
|
| Rate for Payer: BCBS Complete |
$114.92
|
| Rate for Payer: BCBS Complete |
$96.97
|
| Rate for Payer: BCBS Complete |
$114.92
|
| Rate for Payer: BCBS Complete |
$96.97
|
| Rate for Payer: BCBS Trust/PPO |
$199.88
|
| Rate for Payer: BCBS Trust/PPO |
$236.88
|
| Rate for Payer: BCBS Trust/PPO |
$236.87
|
| Rate for Payer: BCBS Trust/PPO |
$199.88
|
| Rate for Payer: BCN Commercial |
$236.88
|
| Rate for Payer: BCN Commercial |
$236.87
|
| Rate for Payer: BCN Commercial |
$199.88
|
| Rate for Payer: BCN Commercial |
$199.88
|
| Rate for Payer: Cash Price |
$193.94
|
| Rate for Payer: Cash Price |
$229.83
|
| Rate for Payer: Cash Price |
$229.84
|
| Rate for Payer: Cash Price |
$193.94
|
| Rate for Payer: Cash Price |
$193.94
|
| Rate for Payer: Cash Price |
$193.94
|
| Rate for Payer: Cash Price |
$229.84
|
| Rate for Payer: Cash Price |
$229.83
|
| Rate for Payer: Cofinity Commercial |
$270.06
|
| Rate for Payer: Cofinity Commercial |
$227.88
|
| Rate for Payer: Cofinity Commercial |
$270.05
|
| Rate for Payer: Cofinity Commercial |
$227.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.83
|
| Rate for Payer: Healthscope Commercial |
$278.68
|
| Rate for Payer: Healthscope Commercial |
$235.15
|
| Rate for Payer: Healthscope Commercial |
$235.16
|
| Rate for Payer: Healthscope Commercial |
$278.67
|
| Rate for Payer: Healthscope Whirlpool |
$242.43
|
| Rate for Payer: Healthscope Whirlpool |
$287.29
|
| Rate for Payer: Healthscope Whirlpool |
$287.30
|
| Rate for Payer: Healthscope Whirlpool |
$242.43
|
| Rate for Payer: Mclaren Commercial |
$258.56
|
| Rate for Payer: Mclaren Commercial |
$218.19
|
| Rate for Payer: Mclaren Commercial |
$218.18
|
| Rate for Payer: Mclaren Commercial |
$258.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.21
|
| Rate for Payer: Nomi Health Commercial |
$198.79
|
| Rate for Payer: Nomi Health Commercial |
$235.58
|
| Rate for Payer: Nomi Health Commercial |
$235.59
|
| Rate for Payer: Nomi Health Commercial |
$198.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$83.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$83.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$83.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$83.57
|
| Rate for Payer: Priority Health Narrow Network |
$66.86
|
| Rate for Payer: Priority Health Narrow Network |
$66.86
|
| Rate for Payer: Priority Health Narrow Network |
$66.86
|
| Rate for Payer: Priority Health Narrow Network |
$66.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.34
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$287.29
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
11283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$215.47 |
| Max. Negotiated Rate |
$287.29 |
| Rate for Payer: Aetna Commercial |
$258.56
|
| Rate for Payer: Aetna Commercial |
$218.19
|
| Rate for Payer: Aetna Commercial |
$258.57
|
| Rate for Payer: Aetna Commercial |
$218.18
|
| Rate for Payer: ASR ASR |
$278.68
|
| Rate for Payer: ASR ASR |
$278.67
|
| Rate for Payer: ASR ASR |
$235.16
|
| Rate for Payer: ASR ASR |
$235.15
|
| Rate for Payer: BCBS Trust/PPO |
$235.92
|
| Rate for Payer: BCBS Trust/PPO |
$199.08
|
| Rate for Payer: BCBS Trust/PPO |
$199.08
|
| Rate for Payer: BCBS Trust/PPO |
$235.93
|
| Rate for Payer: BCN Commercial |
$199.08
|
| Rate for Payer: BCN Commercial |
$235.93
|
| Rate for Payer: BCN Commercial |
$199.08
|
| Rate for Payer: BCN Commercial |
$235.92
|
| Rate for Payer: Cash Price |
$229.84
|
| Rate for Payer: Cash Price |
$193.94
|
| Rate for Payer: Cash Price |
$229.83
|
| Rate for Payer: Cash Price |
$193.94
|
| Rate for Payer: Cofinity Commercial |
$270.05
|
| Rate for Payer: Cofinity Commercial |
$227.88
|
| Rate for Payer: Cofinity Commercial |
$270.06
|
| Rate for Payer: Cofinity Commercial |
$227.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.94
|
| Rate for Payer: Healthscope Commercial |
$278.67
|
| Rate for Payer: Healthscope Commercial |
$235.15
|
| Rate for Payer: Healthscope Commercial |
$235.16
|
| Rate for Payer: Healthscope Commercial |
$278.68
|
| Rate for Payer: Healthscope Whirlpool |
$287.29
|
| Rate for Payer: Healthscope Whirlpool |
$287.30
|
| Rate for Payer: Healthscope Whirlpool |
$242.43
|
| Rate for Payer: Healthscope Whirlpool |
$242.43
|
| Rate for Payer: Mclaren Commercial |
$218.18
|
| Rate for Payer: Mclaren Commercial |
$258.57
|
| Rate for Payer: Mclaren Commercial |
$218.19
|
| Rate for Payer: Mclaren Commercial |
$258.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.06
|
| Rate for Payer: Nomi Health Commercial |
$198.79
|
| Rate for Payer: Nomi Health Commercial |
$235.59
|
| Rate for Payer: Nomi Health Commercial |
$235.58
|
| Rate for Payer: Nomi Health Commercial |
$198.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.83
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$53.58
|
|
|
Service Code
|
NDC 68382011414
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.19 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$48.22
|
| Rate for Payer: ASR ASR |
$51.97
|
| Rate for Payer: BCBS Trust/PPO |
$44.00
|
| Rate for Payer: BCN Commercial |
$44.00
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Commercial |
$50.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.86
|
| Rate for Payer: Healthscope Commercial |
$51.97
|
| Rate for Payer: Healthscope Whirlpool |
$53.58
|
| Rate for Payer: Mclaren Commercial |
$48.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.54
|
| Rate for Payer: Nomi Health Commercial |
$43.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.15
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$338.40
|
|
|
Service Code
|
NDC 904635961
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.21 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: Aetna Medicare |
$125.21
|
| Rate for Payer: ASR ASR |
$328.25
|
| Rate for Payer: BCBS Complete |
$135.36
|
| Rate for Payer: BCBS Trust/PPO |
$279.01
|
| Rate for Payer: BCN Commercial |
$279.01
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$318.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$328.25
|
| Rate for Payer: Healthscope Whirlpool |
$338.40
|
| Rate for Payer: Mclaren Commercial |
$304.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Nomi Health Commercial |
$277.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$296.51
|
| Rate for Payer: Priority Health Narrow Network |
$237.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.79
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$272.65
|
|
|
Service Code
|
NDC 904736261
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.88 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Aetna Commercial |
$245.38
|
| Rate for Payer: Aetna Medicare |
$100.88
|
| Rate for Payer: ASR ASR |
$264.47
|
| Rate for Payer: BCBS Complete |
$109.06
|
| Rate for Payer: BCBS Trust/PPO |
$224.80
|
| Rate for Payer: BCN Commercial |
$224.80
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$256.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$264.47
|
| Rate for Payer: Healthscope Whirlpool |
$272.65
|
| Rate for Payer: Mclaren Commercial |
$245.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.75
|
| Rate for Payer: Nomi Health Commercial |
$223.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$238.90
|
| Rate for Payer: Priority Health Narrow Network |
$191.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.93
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$272.65
|
|
|
Service Code
|
NDC 904736261
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.49 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Aetna Commercial |
$245.38
|
| Rate for Payer: ASR ASR |
$264.47
|
| Rate for Payer: BCBS Trust/PPO |
$223.90
|
| Rate for Payer: BCN Commercial |
$223.90
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$256.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$264.47
|
| Rate for Payer: Healthscope Whirlpool |
$272.65
|
| Rate for Payer: Mclaren Commercial |
$245.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.75
|
| Rate for Payer: Nomi Health Commercial |
$223.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.93
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 904635961
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.80 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: ASR ASR |
$328.25
|
| Rate for Payer: BCBS Trust/PPO |
$277.89
|
| Rate for Payer: BCN Commercial |
$277.89
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$318.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$328.25
|
| Rate for Payer: Healthscope Whirlpool |
$338.40
|
| Rate for Payer: Mclaren Commercial |
$304.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Nomi Health Commercial |
$277.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.79
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$53.58
|
|
|
Service Code
|
NDC 68382011414
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.82 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$48.22
|
| Rate for Payer: Aetna Medicare |
$19.82
|
| Rate for Payer: ASR ASR |
$51.97
|
| Rate for Payer: BCBS Complete |
$21.43
|
| Rate for Payer: BCBS Trust/PPO |
$44.18
|
| Rate for Payer: BCN Commercial |
$44.18
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Commercial |
$50.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.86
|
| Rate for Payer: Healthscope Commercial |
$51.97
|
| Rate for Payer: Healthscope Whirlpool |
$53.58
|
| Rate for Payer: Mclaren Commercial |
$48.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.54
|
| Rate for Payer: Nomi Health Commercial |
$43.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.95
|
| Rate for Payer: Priority Health Narrow Network |
$37.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.15
|
|
|
RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,665.18
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
192042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$2,665.18 |
| Rate for Payer: Aetna Commercial |
$2,398.66
|
| Rate for Payer: Aetna Medicare |
$31.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.10
|
| Rate for Payer: ASR ASR |
$2,585.22
|
| Rate for Payer: BCBS Complete |
$17.18
|
| Rate for Payer: BCBS MAPPO |
$31.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,197.44
|
| Rate for Payer: BCN Commercial |
$2,197.44
|
| Rate for Payer: BCN Medicare Advantage |
$31.28
|
| Rate for Payer: Cash Price |
$2,132.14
|
| Rate for Payer: Cash Price |
$2,132.14
|
| Rate for Payer: Cofinity Commercial |
$2,505.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,132.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.28
|
| Rate for Payer: Healthscope Commercial |
$2,585.22
|
| Rate for Payer: Healthscope Whirlpool |
$2,665.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$31.28
|
| Rate for Payer: Mclaren Commercial |
$2,398.66
|
| Rate for Payer: Mclaren Medicaid |
$31.28
|
| Rate for Payer: Mclaren Medicare |
$31.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.84
|
| Rate for Payer: Meridian Medicaid |
$17.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,265.40
|
| Rate for Payer: Nomi Health Commercial |
$2,185.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,998.88
|
| Rate for Payer: PACE Medicare |
$29.72
|
| Rate for Payer: PACE SWMI |
$31.28
|
| Rate for Payer: PHP Commercial |
$34.41
|
| Rate for Payer: PHP Medicaid |
$16.77
|
| Rate for Payer: PHP Medicare Advantage |
$31.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$26.95
|
| Rate for Payer: Priority Health Medicare |
$31.28
|
| Rate for Payer: Priority Health Narrow Network |
$21.56
|
| Rate for Payer: Railroad Medicare Medicare |
$31.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,345.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.28
|
| Rate for Payer: UHC Exchange |
$48.48
|
| Rate for Payer: UHC Medicaid |
$16.36
|
| Rate for Payer: UHCCP DNSP |
$31.28
|
| Rate for Payer: UHCCP Medicaid |
$16.36
|
| Rate for Payer: VA VA |
$31.28
|
|
|
RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,665.18
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
192042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,998.88 |
| Max. Negotiated Rate |
$2,665.18 |
| Rate for Payer: Aetna Commercial |
$2,398.66
|
| Rate for Payer: ASR ASR |
$2,585.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,188.64
|
| Rate for Payer: BCN Commercial |
$2,188.64
|
| Rate for Payer: Cash Price |
$2,132.14
|
| Rate for Payer: Cofinity Commercial |
$2,505.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,132.14
|
| Rate for Payer: Healthscope Commercial |
$2,585.22
|
| Rate for Payer: Healthscope Whirlpool |
$2,665.18
|
| Rate for Payer: Mclaren Commercial |
$2,398.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,265.40
|
| Rate for Payer: Nomi Health Commercial |
$2,185.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,998.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,345.35
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
OP
|
$1,618.16
|
|
|
Service Code
|
NDC 50458058030
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$598.72 |
| Max. Negotiated Rate |
$1,618.16 |
| Rate for Payer: Aetna Commercial |
$1,456.34
|
| Rate for Payer: Aetna Medicare |
$598.72
|
| Rate for Payer: ASR ASR |
$1,569.61
|
| Rate for Payer: BCBS Complete |
$647.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,334.17
|
| Rate for Payer: BCN Commercial |
$1,334.17
|
| Rate for Payer: Cash Price |
$1,294.53
|
| Rate for Payer: Cofinity Commercial |
$1,521.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.53
|
| Rate for Payer: Healthscope Commercial |
$1,569.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,618.16
|
| Rate for Payer: Mclaren Commercial |
$1,456.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,294.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.43
|
| Rate for Payer: Nomi Health Commercial |
$1,326.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,213.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,417.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,134.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,423.98
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
IP
|
$1,618.16
|
|
|
Service Code
|
NDC 50458058030
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,213.62 |
| Max. Negotiated Rate |
$1,618.16 |
| Rate for Payer: Aetna Commercial |
$1,456.34
|
| Rate for Payer: ASR ASR |
$1,569.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,328.83
|
| Rate for Payer: BCN Commercial |
$1,328.83
|
| Rate for Payer: Cash Price |
$1,294.53
|
| Rate for Payer: Cofinity Commercial |
$1,521.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.53
|
| Rate for Payer: Healthscope Commercial |
$1,569.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,618.16
|
| Rate for Payer: Mclaren Commercial |
$1,456.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.43
|
| Rate for Payer: Nomi Health Commercial |
$1,326.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,213.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,423.98
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
IP
|
$1,618.16
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,213.62 |
| Max. Negotiated Rate |
$1,618.16 |
| Rate for Payer: Aetna Commercial |
$1,456.34
|
| Rate for Payer: ASR ASR |
$1,569.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,328.83
|
| Rate for Payer: BCN Commercial |
$1,328.83
|
| Rate for Payer: Cash Price |
$1,294.53
|
| Rate for Payer: Cofinity Commercial |
$1,521.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.53
|
| Rate for Payer: Healthscope Commercial |
$1,569.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,618.16
|
| Rate for Payer: Mclaren Commercial |
$1,456.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.43
|
| Rate for Payer: Nomi Health Commercial |
$1,326.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,213.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,423.98
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
OP
|
$1,618.16
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$598.72 |
| Max. Negotiated Rate |
$1,618.16 |
| Rate for Payer: Aetna Commercial |
$1,456.34
|
| Rate for Payer: Aetna Medicare |
$598.72
|
| Rate for Payer: ASR ASR |
$1,569.61
|
| Rate for Payer: BCBS Complete |
$647.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,334.17
|
| Rate for Payer: BCN Commercial |
$1,334.17
|
| Rate for Payer: Cash Price |
$1,294.53
|
| Rate for Payer: Cofinity Commercial |
$1,521.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.53
|
| Rate for Payer: Healthscope Commercial |
$1,569.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,618.16
|
| Rate for Payer: Mclaren Commercial |
$1,456.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,294.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.43
|
| Rate for Payer: Nomi Health Commercial |
$1,326.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,213.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,417.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,134.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,423.98
|
|
