|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$135.30
|
|
|
Service Code
|
NDC 0904-7224-61
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.24 |
| Max. Negotiated Rate |
$121.77 |
| Rate for Payer: Aetna Commercial |
$115.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.94
|
| Rate for Payer: Cash Price |
$108.24
|
| Rate for Payer: Cofinity Commercial |
$116.36
|
| Rate for Payer: Cofinity Commercial |
$94.71
|
| Rate for Payer: Healthscope Commercial |
$121.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.00
|
| Rate for Payer: PHP Commercial |
$115.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.71
|
| Rate for Payer: Priority Health SBD |
$85.24
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$1.56
|
|
|
Service Code
|
NDC 60687-681-11
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna Commercial |
$1.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.01
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cofinity Commercial |
$1.34
|
| Rate for Payer: Cofinity Commercial |
$1.09
|
| Rate for Payer: Healthscope Commercial |
$1.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.33
|
| Rate for Payer: PHP Commercial |
$1.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.09
|
| Rate for Payer: Priority Health SBD |
$0.98
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$203.55
|
|
|
Service Code
|
NDC 63323-184-10
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$128.24 |
| Max. Negotiated Rate |
$183.20 |
| Rate for Payer: Aetna Commercial |
$173.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.31
|
| Rate for Payer: Cash Price |
$162.84
|
| Rate for Payer: Cofinity Commercial |
$142.48
|
| Rate for Payer: Cofinity Commercial |
$175.05
|
| Rate for Payer: Healthscope Commercial |
$183.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.02
|
| Rate for Payer: PHP Commercial |
$173.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.48
|
| Rate for Payer: Priority Health SBD |
$128.24
|
|
|
FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,624.90
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
22185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,023.69 |
| Max. Negotiated Rate |
$1,462.41 |
| Rate for Payer: Aetna Commercial |
$1,381.16
|
| Rate for Payer: Aetna Commercial |
$2,727.73
|
| Rate for Payer: Aetna Commercial |
$2,494.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,056.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,907.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,085.91
|
| Rate for Payer: Cash Price |
$1,299.92
|
| Rate for Payer: Cash Price |
$2,567.27
|
| Rate for Payer: Cash Price |
$2,347.45
|
| Rate for Payer: Cofinity Commercial |
$2,054.02
|
| Rate for Payer: Cofinity Commercial |
$2,246.36
|
| Rate for Payer: Cofinity Commercial |
$1,137.43
|
| Rate for Payer: Cofinity Commercial |
$1,397.41
|
| Rate for Payer: Cofinity Commercial |
$2,523.51
|
| Rate for Payer: Cofinity Commercial |
$2,759.82
|
| Rate for Payer: Healthscope Commercial |
$2,640.88
|
| Rate for Payer: Healthscope Commercial |
$1,462.41
|
| Rate for Payer: Healthscope Commercial |
$2,888.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,494.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,381.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,727.73
|
| Rate for Payer: PHP Commercial |
$2,727.73
|
| Rate for Payer: PHP Commercial |
$1,381.16
|
| Rate for Payer: PHP Commercial |
$2,494.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,054.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,137.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,246.36
|
| Rate for Payer: Priority Health SBD |
$1,848.62
|
| Rate for Payer: Priority Health SBD |
$1,023.69
|
| Rate for Payer: Priority Health SBD |
$2,021.73
|
|
|
FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
IP
|
$163.76
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
115590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$147.38 |
| Rate for Payer: Aetna Commercial |
$139.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.44
|
| Rate for Payer: Cash Price |
$131.01
|
| Rate for Payer: Cofinity Commercial |
$114.63
|
| Rate for Payer: Cofinity Commercial |
$140.83
|
| Rate for Payer: Healthscope Commercial |
$147.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.20
|
| Rate for Payer: PHP Commercial |
$139.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.63
|
| Rate for Payer: Priority Health SBD |
$103.17
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
IP
|
$25.28
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
32215
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Commercial |
$21.49
|
| Rate for Payer: Aetna Commercial |
$43.10
|
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.43
|
| Rate for Payer: Cash Price |
$40.57
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cash Price |
$20.22
|
| Rate for Payer: Cofinity Commercial |
$43.61
|
| Rate for Payer: Cofinity Commercial |
$17.70
|
| Rate for Payer: Cofinity Commercial |
$21.74
|
| Rate for Payer: Cofinity Commercial |
$23.05
|
| Rate for Payer: Cofinity Commercial |
$28.32
|
| Rate for Payer: Cofinity Commercial |
$35.50
|
| Rate for Payer: Healthscope Commercial |
$29.64
|
| Rate for Payer: Healthscope Commercial |
$22.75
|
| Rate for Payer: Healthscope Commercial |
$45.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.99
|
| Rate for Payer: PHP Commercial |
$21.49
|
| Rate for Payer: PHP Commercial |
$43.10
|
| Rate for Payer: PHP Commercial |
$27.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.50
|
| Rate for Payer: Priority Health SBD |
$15.93
|
| Rate for Payer: Priority Health SBD |
$31.95
|
| Rate for Payer: Priority Health SBD |
$20.75
|
|
|
FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
IP
|
$65.81
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
115589
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.46 |
| Max. Negotiated Rate |
$59.23 |
| Rate for Payer: Aetna Commercial |
$55.94
|
| Rate for Payer: Aetna Commercial |
$69.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.78
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$65.85
|
| Rate for Payer: Cofinity Commercial |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$46.07
|
| Rate for Payer: Cofinity Commercial |
$57.62
|
| Rate for Payer: Cofinity Commercial |
$70.79
|
| Rate for Payer: Healthscope Commercial |
$74.08
|
| Rate for Payer: Healthscope Commercial |
$59.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.96
|
| Rate for Payer: PHP Commercial |
$69.96
|
| Rate for Payer: PHP Commercial |
$55.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.62
|
| Rate for Payer: Priority Health SBD |
$41.46
|
| Rate for Payer: Priority Health SBD |
$51.86
|
|
|
FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
OP
|
$192.82
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
39803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$173.54 |
| Rate for Payer: Aetna Commercial |
$163.90
|
| Rate for Payer: Aetna Commercial |
$107.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.01
|
| Rate for Payer: BCBS Complete |
$50.47
|
| Rate for Payer: BCBS Complete |
$77.13
|
| Rate for Payer: BCBS Trust/PPO |
$3.23
|
| Rate for Payer: BCBS Trust/PPO |
$3.23
|
| Rate for Payer: Cash Price |
$154.26
|
| Rate for Payer: Cash Price |
$154.26
|
| Rate for Payer: Cash Price |
$100.94
|
| Rate for Payer: Cash Price |
$100.94
|
| Rate for Payer: Cofinity Commercial |
$88.32
|
| Rate for Payer: Cofinity Commercial |
$108.51
|
| Rate for Payer: Cofinity Commercial |
$134.97
|
| Rate for Payer: Cofinity Commercial |
$165.83
|
| Rate for Payer: Healthscope Commercial |
$173.54
|
| Rate for Payer: Healthscope Commercial |
$113.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.24
|
| Rate for Payer: PHP Commercial |
$107.24
|
| Rate for Payer: PHP Commercial |
$163.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.32
|
| Rate for Payer: Priority Health SBD |
$79.49
|
| Rate for Payer: Priority Health SBD |
$121.48
|
|
|
FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
IP
|
$126.17
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
39803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.49 |
| Max. Negotiated Rate |
$113.55 |
| Rate for Payer: Aetna Commercial |
$107.24
|
| Rate for Payer: Aetna Commercial |
$163.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.33
|
| Rate for Payer: Cash Price |
$154.26
|
| Rate for Payer: Cash Price |
$100.94
|
| Rate for Payer: Cofinity Commercial |
$165.83
|
| Rate for Payer: Cofinity Commercial |
$88.32
|
| Rate for Payer: Cofinity Commercial |
$108.51
|
| Rate for Payer: Cofinity Commercial |
$134.97
|
| Rate for Payer: Healthscope Commercial |
$173.54
|
| Rate for Payer: Healthscope Commercial |
$113.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.24
|
| Rate for Payer: PHP Commercial |
$107.24
|
| Rate for Payer: PHP Commercial |
$163.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.97
|
| Rate for Payer: Priority Health SBD |
$121.48
|
| Rate for Payer: Priority Health SBD |
$79.49
|
|
|
FOOT PROCEDURES WITH CC
|
Facility
|
IP
|
$31,812.00
|
|
|
Service Code
|
MS-DRG 504
|
| Min. Negotiated Rate |
$12,284.39 |
| Max. Negotiated Rate |
$31,812.00 |
| Rate for Payer: Aetna Medicare |
$13,448.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,163.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,163.68
|
| Rate for Payer: BCBS MAPPO |
$12,930.94
|
| Rate for Payer: BCBS Trust/PPO |
$31,812.00
|
| Rate for Payer: BCN Medicare Advantage |
$12,930.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,930.94
|
| Rate for Payer: Mclaren Medicare |
$12,930.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,577.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,870.58
|
| Rate for Payer: PACE Medicare |
$12,284.39
|
| Rate for Payer: PACE SWMI |
$12,930.94
|
| Rate for Payer: PHP Medicare Advantage |
$12,930.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,783.75
|
| Rate for Payer: Priority Health Medicare |
$12,930.94
|
| Rate for Payer: Priority Health Narrow Network |
$19,827.00
|
| Rate for Payer: Railroad Medicare Medicare |
$12,930.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,345.18
|
| Rate for Payer: UHC Core |
$16,165.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,930.94
|
| Rate for Payer: UHC Exchange |
$17,314.18
|
| Rate for Payer: UHC Medicare Advantage |
$13,318.87
|
| Rate for Payer: VA VA |
$12,930.94
|
|
|
FOOT PROCEDURES WITH MCC
|
Facility
|
IP
|
$40,909.70
|
|
|
Service Code
|
MS-DRG 503
|
| Min. Negotiated Rate |
$18,816.86 |
| Max. Negotiated Rate |
$40,909.70 |
| Rate for Payer: Aetna Medicare |
$20,599.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,759.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,759.02
|
| Rate for Payer: BCBS MAPPO |
$19,807.22
|
| Rate for Payer: BCBS Trust/PPO |
$33,434.77
|
| Rate for Payer: BCN Medicare Advantage |
$19,807.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,807.22
|
| Rate for Payer: Mclaren Medicare |
$19,807.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,797.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,778.30
|
| Rate for Payer: PACE Medicare |
$18,816.86
|
| Rate for Payer: PACE SWMI |
$19,807.22
|
| Rate for Payer: PHP Medicare Advantage |
$19,807.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,485.05
|
| Rate for Payer: Priority Health Medicare |
$19,807.22
|
| Rate for Payer: Priority Health Narrow Network |
$30,788.04
|
| Rate for Payer: Railroad Medicare Medicare |
$19,807.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40,909.70
|
| Rate for Payer: UHC Core |
$25,102.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,807.22
|
| Rate for Payer: UHC Exchange |
$26,886.05
|
| Rate for Payer: UHC Medicare Advantage |
$20,401.44
|
| Rate for Payer: VA VA |
$19,807.22
|
|
|
FOOT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$26,018.75
|
|
|
Service Code
|
MS-DRG 505
|
| Min. Negotiated Rate |
$12,137.99 |
| Max. Negotiated Rate |
$26,018.75 |
| Rate for Payer: Aetna Medicare |
$13,287.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,971.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,971.04
|
| Rate for Payer: BCBS MAPPO |
$12,776.83
|
| Rate for Payer: BCBS Trust/PPO |
$24,084.63
|
| Rate for Payer: BCN Medicare Advantage |
$12,776.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,776.83
|
| Rate for Payer: Mclaren Medicare |
$12,776.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,415.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,693.35
|
| Rate for Payer: PACE Medicare |
$12,137.99
|
| Rate for Payer: PACE SWMI |
$12,776.83
|
| Rate for Payer: PHP Medicare Advantage |
$12,776.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,476.66
|
| Rate for Payer: Priority Health Medicare |
$12,776.83
|
| Rate for Payer: Priority Health Narrow Network |
$19,581.33
|
| Rate for Payer: Railroad Medicare Medicare |
$12,776.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,018.75
|
| Rate for Payer: UHC Core |
$15,965.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,776.83
|
| Rate for Payer: UHC Exchange |
$17,099.64
|
| Rate for Payer: UHC Medicare Advantage |
$13,160.13
|
| Rate for Payer: VA VA |
$12,776.83
|
|
|
FOREHEAD FLAP WITH PRESERVATION OF VASCULAR PEDICLE (EG, AXIAL PATTERN FLAP, PARAMEDIAN FOREHEAD FLAP)
|
Facility
|
OP
|
$9,754.38
|
|
|
Service Code
|
CPT 15731
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$979.71 |
| Max. Negotiated Rate |
$9,754.38 |
| Rate for Payer: Aetna Medicare |
$3,319.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,990.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,990.30
|
| Rate for Payer: BCBS Complete |
$1,833.62
|
| Rate for Payer: BCBS MAPPO |
$3,192.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,370.72
|
| Rate for Payer: BCN Medicare Advantage |
$3,192.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,192.24
|
| Rate for Payer: Mclaren Medicaid |
$1,746.16
|
| Rate for Payer: Mclaren Medicare |
$3,192.24
|
| Rate for Payer: Meridian Medicaid |
$1,833.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,351.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,671.08
|
| Rate for Payer: PACE Medicare |
$3,032.63
|
| Rate for Payer: PACE SWMI |
$3,192.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,192.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,746.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,754.38
|
| Rate for Payer: Priority Health Medicare |
$3,192.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,803.50
|
| Rate for Payer: Railroad Medicare Medicare |
$3,192.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,077.68
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,192.24
|
| Rate for Payer: UHC Exchange |
$979.71
|
| Rate for Payer: UHC Medicare Advantage |
$3,288.01
|
| Rate for Payer: VA VA |
$3,192.24
|
|
|
FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$16.17
|
|
|
Service Code
|
HCPCS J7606
|
| Hospital Charge Code |
88225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.51
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cofinity Commercial |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Healthscope Commercial |
$14.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.74
|
| Rate for Payer: PHP Commercial |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.32
|
| Rate for Payer: Priority Health SBD |
$10.19
|
|
|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$1,478.25
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
106783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1,330.42 |
| Rate for Payer: Aetna Commercial |
$1,256.51
|
| Rate for Payer: Aetna Commercial |
$320.10
|
| Rate for Payer: Aetna Commercial |
$475.69
|
| Rate for Payer: Aetna Commercial |
$217.39
|
| Rate for Payer: Aetna Commercial |
$364.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$363.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.86
|
| Rate for Payer: BCBS Complete |
$591.30
|
| Rate for Payer: BCBS Complete |
$223.85
|
| Rate for Payer: BCBS Complete |
$150.64
|
| Rate for Payer: BCBS Complete |
$102.30
|
| Rate for Payer: BCBS Complete |
$171.54
|
| Rate for Payer: BCBS Trust/PPO |
$0.41
|
| Rate for Payer: BCBS Trust/PPO |
$0.41
|
| Rate for Payer: BCBS Trust/PPO |
$0.41
|
| Rate for Payer: BCBS Trust/PPO |
$0.41
|
| Rate for Payer: BCBS Trust/PPO |
$0.41
|
| Rate for Payer: Cash Price |
$1,182.60
|
| Rate for Payer: Cash Price |
$447.70
|
| Rate for Payer: Cash Price |
$301.27
|
| Rate for Payer: Cash Price |
$447.70
|
| Rate for Payer: Cash Price |
$1,182.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$343.09
|
| Rate for Payer: Cash Price |
$301.27
|
| Rate for Payer: Cash Price |
$343.09
|
| Rate for Payer: Cofinity Commercial |
$263.61
|
| Rate for Payer: Cofinity Commercial |
$1,034.78
|
| Rate for Payer: Cofinity Commercial |
$1,271.30
|
| Rate for Payer: Cofinity Commercial |
$179.02
|
| Rate for Payer: Cofinity Commercial |
$219.94
|
| Rate for Payer: Cofinity Commercial |
$323.87
|
| Rate for Payer: Cofinity Commercial |
$300.20
|
| Rate for Payer: Cofinity Commercial |
$368.82
|
| Rate for Payer: Cofinity Commercial |
$391.74
|
| Rate for Payer: Cofinity Commercial |
$481.28
|
| Rate for Payer: Healthscope Commercial |
$338.93
|
| Rate for Payer: Healthscope Commercial |
$1,330.42
|
| Rate for Payer: Healthscope Commercial |
$385.97
|
| Rate for Payer: Healthscope Commercial |
$503.67
|
| Rate for Payer: Healthscope Commercial |
$230.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$475.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,256.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.10
|
| Rate for Payer: PHP Commercial |
$320.10
|
| Rate for Payer: PHP Commercial |
$475.69
|
| Rate for Payer: PHP Commercial |
$1,256.51
|
| Rate for Payer: PHP Commercial |
$217.39
|
| Rate for Payer: PHP Commercial |
$364.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.74
|
| Rate for Payer: Priority Health SBD |
$270.18
|
| Rate for Payer: Priority Health SBD |
$237.25
|
| Rate for Payer: Priority Health SBD |
$352.57
|
| Rate for Payer: Priority Health SBD |
$161.12
|
| Rate for Payer: Priority Health SBD |
$931.30
|
|
|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$213.63
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
106783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.59 |
| Max. Negotiated Rate |
$192.27 |
| Rate for Payer: Aetna Commercial |
$181.59
|
| Rate for Payer: Aetna Commercial |
$1,256.51
|
| Rate for Payer: Aetna Commercial |
$442.42
|
| Rate for Payer: Aetna Commercial |
$364.53
|
| Rate for Payer: Aetna Commercial |
$175.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.15
|
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cash Price |
$170.90
|
| Rate for Payer: Cash Price |
$165.10
|
| Rate for Payer: Cash Price |
$1,182.60
|
| Rate for Payer: Cash Price |
$343.09
|
| Rate for Payer: Cofinity Commercial |
$149.54
|
| Rate for Payer: Cofinity Commercial |
$1,034.78
|
| Rate for Payer: Cofinity Commercial |
$1,271.30
|
| Rate for Payer: Cofinity Commercial |
$144.47
|
| Rate for Payer: Cofinity Commercial |
$177.49
|
| Rate for Payer: Cofinity Commercial |
$183.72
|
| Rate for Payer: Cofinity Commercial |
$300.20
|
| Rate for Payer: Cofinity Commercial |
$368.82
|
| Rate for Payer: Cofinity Commercial |
$364.35
|
| Rate for Payer: Cofinity Commercial |
$447.63
|
| Rate for Payer: Healthscope Commercial |
$1,330.42
|
| Rate for Payer: Healthscope Commercial |
$185.74
|
| Rate for Payer: Healthscope Commercial |
$468.45
|
| Rate for Payer: Healthscope Commercial |
$192.27
|
| Rate for Payer: Healthscope Commercial |
$385.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,256.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$442.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$181.59
|
| Rate for Payer: PHP Commercial |
$364.53
|
| Rate for Payer: PHP Commercial |
$181.59
|
| Rate for Payer: PHP Commercial |
$175.42
|
| Rate for Payer: PHP Commercial |
$1,256.51
|
| Rate for Payer: PHP Commercial |
$442.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.78
|
| Rate for Payer: Priority Health SBD |
$270.18
|
| Rate for Payer: Priority Health SBD |
$931.30
|
| Rate for Payer: Priority Health SBD |
$130.02
|
| Rate for Payer: Priority Health SBD |
$134.59
|
| Rate for Payer: Priority Health SBD |
$327.92
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$241.84
|
|
|
Service Code
|
NDC 0456-4300-01
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.36 |
| Max. Negotiated Rate |
$217.66 |
| Rate for Payer: Aetna Commercial |
$205.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.20
|
| Rate for Payer: Cash Price |
$193.47
|
| Rate for Payer: Cofinity Commercial |
$169.29
|
| Rate for Payer: Cofinity Commercial |
$207.98
|
| Rate for Payer: Healthscope Commercial |
$217.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.56
|
| Rate for Payer: PHP Commercial |
$205.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.29
|
| Rate for Payer: Priority Health SBD |
$152.36
|
|
|
FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$15.52
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
17764
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.78 |
| Max. Negotiated Rate |
$13.97 |
| Rate for Payer: Aetna Commercial |
$13.19
|
| Rate for Payer: Aetna Commercial |
$16.89
|
| Rate for Payer: Aetna Commercial |
$34.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.60
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cash Price |
$32.74
|
| Rate for Payer: Cofinity Commercial |
$13.35
|
| Rate for Payer: Cofinity Commercial |
$10.86
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$28.64
|
| Rate for Payer: Cofinity Commercial |
$35.19
|
| Rate for Payer: Healthscope Commercial |
$36.83
|
| Rate for Payer: Healthscope Commercial |
$13.97
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.19
|
| Rate for Payer: PHP Commercial |
$16.89
|
| Rate for Payer: PHP Commercial |
$34.78
|
| Rate for Payer: PHP Commercial |
$13.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.91
|
| Rate for Payer: Priority Health SBD |
$25.78
|
| Rate for Payer: Priority Health SBD |
$9.78
|
| Rate for Payer: Priority Health SBD |
$12.52
|
|
|
FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION
|
Facility
|
IP
|
$93.14
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
88010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.68 |
| Max. Negotiated Rate |
$83.83 |
| Rate for Payer: Aetna Commercial |
$79.17
|
| Rate for Payer: Aetna Commercial |
$45.17
|
| Rate for Payer: Aetna Commercial |
$52.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.21
|
| Rate for Payer: Cash Price |
$42.51
|
| Rate for Payer: Cash Price |
$74.51
|
| Rate for Payer: Cash Price |
$49.49
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Cofinity Commercial |
$80.10
|
| Rate for Payer: Cofinity Commercial |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$37.20
|
| Rate for Payer: Cofinity Commercial |
$43.30
|
| Rate for Payer: Cofinity Commercial |
$53.20
|
| Rate for Payer: Healthscope Commercial |
$55.67
|
| Rate for Payer: Healthscope Commercial |
$47.83
|
| Rate for Payer: Healthscope Commercial |
$83.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.17
|
| Rate for Payer: PHP Commercial |
$52.58
|
| Rate for Payer: PHP Commercial |
$45.17
|
| Rate for Payer: PHP Commercial |
$79.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.30
|
| Rate for Payer: Priority Health SBD |
$38.97
|
| Rate for Payer: Priority Health SBD |
$33.48
|
| Rate for Payer: Priority Health SBD |
$58.68
|
|
|
FRACTURE NASAL INFERIOR TURBINATE(S), THERAPEUTIC
|
Facility
|
OP
|
$8,530.92
|
|
|
Service Code
|
CPT 30930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$117.55 |
| Max. Negotiated Rate |
$8,530.92 |
| Rate for Payer: Aetna Medicare |
$2,979.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,580.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,580.99
|
| Rate for Payer: BCBS Complete |
$1,645.54
|
| Rate for Payer: BCBS MAPPO |
$2,864.79
|
| Rate for Payer: BCBS Trust/PPO |
$952.38
|
| Rate for Payer: BCN Medicare Advantage |
$2,864.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,864.79
|
| Rate for Payer: Mclaren Medicaid |
$1,567.04
|
| Rate for Payer: Mclaren Medicare |
$2,864.79
|
| Rate for Payer: Meridian Medicaid |
$1,645.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,008.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,294.51
|
| Rate for Payer: PACE Medicare |
$2,721.55
|
| Rate for Payer: PACE SWMI |
$2,864.79
|
| Rate for Payer: PHP Medicare Advantage |
$2,864.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,567.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,530.92
|
| Rate for Payer: Priority Health Medicare |
$2,864.79
|
| Rate for Payer: Priority Health Narrow Network |
$6,824.74
|
| Rate for Payer: Railroad Medicare Medicare |
$2,864.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.30
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,864.79
|
| Rate for Payer: UHC Exchange |
$117.55
|
| Rate for Payer: UHC Medicare Advantage |
$2,950.73
|
| Rate for Payer: VA VA |
$2,864.79
|
|
|
FRACTURES OF FEMUR WITH MCC
|
Facility
|
IP
|
$24,885.38
|
|
|
Service Code
|
MS-DRG 533
|
| Min. Negotiated Rate |
$11,629.64 |
| Max. Negotiated Rate |
$24,885.38 |
| Rate for Payer: Aetna Medicare |
$12,731.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,302.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,302.16
|
| Rate for Payer: BCBS MAPPO |
$12,241.73
|
| Rate for Payer: BCBS Trust/PPO |
$23,377.55
|
| Rate for Payer: BCN Medicare Advantage |
$12,241.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,241.73
|
| Rate for Payer: Mclaren Medicare |
$12,241.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,853.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,077.99
|
| Rate for Payer: PACE Medicare |
$11,629.64
|
| Rate for Payer: PACE SWMI |
$12,241.73
|
| Rate for Payer: PHP Medicare Advantage |
$12,241.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,410.46
|
| Rate for Payer: Priority Health Medicare |
$12,241.73
|
| Rate for Payer: Priority Health Narrow Network |
$18,728.37
|
| Rate for Payer: Railroad Medicare Medicare |
$12,241.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,885.38
|
| Rate for Payer: UHC Core |
$15,269.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,241.73
|
| Rate for Payer: UHC Exchange |
$16,354.79
|
| Rate for Payer: UHC Medicare Advantage |
$12,608.98
|
| Rate for Payer: VA VA |
$12,241.73
|
|
|
FRACTURES OF FEMUR WITHOUT MCC
|
Facility
|
IP
|
$13,065.61
|
|
|
Service Code
|
MS-DRG 534
|
| Min. Negotiated Rate |
$6,009.87 |
| Max. Negotiated Rate |
$13,065.61 |
| Rate for Payer: Aetna Medicare |
$6,579.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,907.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,907.72
|
| Rate for Payer: BCBS MAPPO |
$6,326.18
|
| Rate for Payer: BCBS Trust/PPO |
$13,065.61
|
| Rate for Payer: BCN Medicare Advantage |
$6,326.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,326.18
|
| Rate for Payer: Mclaren Medicare |
$6,326.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,642.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,275.11
|
| Rate for Payer: PACE Medicare |
$6,009.87
|
| Rate for Payer: PACE SWMI |
$6,326.18
|
| Rate for Payer: PHP Medicare Advantage |
$6,326.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,623.44
|
| Rate for Payer: Priority Health Medicare |
$6,326.18
|
| Rate for Payer: Priority Health Narrow Network |
$9,298.75
|
| Rate for Payer: Railroad Medicare Medicare |
$6,326.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,355.74
|
| Rate for Payer: UHC Core |
$7,581.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,326.18
|
| Rate for Payer: UHC Exchange |
$8,120.25
|
| Rate for Payer: UHC Medicare Advantage |
$6,515.97
|
| Rate for Payer: VA VA |
$6,326.18
|
|
|
FRACTURES OF HIP AND PELVIS WITH MCC
|
Facility
|
IP
|
$19,779.86
|
|
|
Service Code
|
MS-DRG 535
|
| Min. Negotiated Rate |
$9,339.74 |
| Max. Negotiated Rate |
$19,779.86 |
| Rate for Payer: Aetna Medicare |
$10,224.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,289.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,289.12
|
| Rate for Payer: BCBS MAPPO |
$9,831.30
|
| Rate for Payer: BCBS Trust/PPO |
$18,177.66
|
| Rate for Payer: BCN Medicare Advantage |
$9,831.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,831.30
|
| Rate for Payer: Mclaren Medicare |
$9,831.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,322.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,306.00
|
| Rate for Payer: PACE Medicare |
$9,339.74
|
| Rate for Payer: PACE SWMI |
$9,831.30
|
| Rate for Payer: PHP Medicare Advantage |
$9,831.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,607.54
|
| Rate for Payer: Priority Health Medicare |
$9,831.30
|
| Rate for Payer: Priority Health Narrow Network |
$14,886.03
|
| Rate for Payer: Railroad Medicare Medicare |
$9,831.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,779.86
|
| Rate for Payer: UHC Core |
$12,137.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,831.30
|
| Rate for Payer: UHC Exchange |
$12,999.42
|
| Rate for Payer: UHC Medicare Advantage |
$10,126.24
|
| Rate for Payer: VA VA |
$9,831.30
|
|
|
FRACTURES OF HIP AND PELVIS WITHOUT MCC
|
Facility
|
IP
|
$12,006.42
|
|
|
Service Code
|
MS-DRG 536
|
| Min. Negotiated Rate |
$5,853.20 |
| Max. Negotiated Rate |
$12,006.42 |
| Rate for Payer: Aetna Medicare |
$6,407.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,701.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,701.58
|
| Rate for Payer: BCBS MAPPO |
$6,161.26
|
| Rate for Payer: BCBS Trust/PPO |
$11,034.40
|
| Rate for Payer: BCN Medicare Advantage |
$6,161.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,161.26
|
| Rate for Payer: Mclaren Medicare |
$6,161.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,469.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,085.45
|
| Rate for Payer: PACE Medicare |
$5,853.20
|
| Rate for Payer: PACE SWMI |
$6,161.26
|
| Rate for Payer: PHP Medicare Advantage |
$6,161.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,294.82
|
| Rate for Payer: Priority Health Medicare |
$6,161.26
|
| Rate for Payer: Priority Health Narrow Network |
$9,035.86
|
| Rate for Payer: Railroad Medicare Medicare |
$6,161.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,006.42
|
| Rate for Payer: UHC Core |
$7,367.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,161.26
|
| Rate for Payer: UHC Exchange |
$7,890.68
|
| Rate for Payer: UHC Medicare Advantage |
$6,346.10
|
| Rate for Payer: VA VA |
$6,161.26
|
|
|
FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC
|
Facility
|
IP
|
$23,196.76
|
|
|
Service Code
|
MS-DRG 562
|
| Min. Negotiated Rate |
$10,872.26 |
| Max. Negotiated Rate |
$23,196.76 |
| Rate for Payer: Aetna Medicare |
$11,902.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,305.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,305.60
|
| Rate for Payer: BCBS MAPPO |
$11,444.48
|
| Rate for Payer: BCBS Trust/PPO |
$20,116.64
|
| Rate for Payer: BCN Medicare Advantage |
$11,444.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,444.48
|
| Rate for Payer: Mclaren Medicare |
$11,444.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,016.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,161.15
|
| Rate for Payer: PACE Medicare |
$10,872.26
|
| Rate for Payer: PACE SWMI |
$11,444.48
|
| Rate for Payer: PHP Medicare Advantage |
$11,444.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,821.92
|
| Rate for Payer: Priority Health Medicare |
$11,444.48
|
| Rate for Payer: Priority Health Narrow Network |
$17,457.54
|
| Rate for Payer: Railroad Medicare Medicare |
$11,444.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,196.76
|
| Rate for Payer: UHC Core |
$14,233.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,444.48
|
| Rate for Payer: UHC Exchange |
$15,245.02
|
| Rate for Payer: UHC Medicare Advantage |
$11,787.81
|
| Rate for Payer: VA VA |
$11,444.48
|
|
