|
TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BLOCK) BILATERAL; BY INJECTIONS (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED)
|
Facility
|
OP
|
$1,071.25
|
|
|
Service Code
|
CPT 64488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,071.25 |
| Max. Negotiated Rate |
$1,071.25 |
| Rate for Payer: BCBS Trust/PPO |
$1,071.25
|
| Rate for Payer: BCN Commercial |
$1,071.25
|
|
|
TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BLOCK) UNILATERAL; BY INJECTION(S) (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED)
|
Facility
|
OP
|
$320.44
|
|
|
Service Code
|
CPT 64486
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$320.44 |
| Rate for Payer: BCBS Trust/PPO |
$320.44
|
| Rate for Payer: BCN Commercial |
$320.44
|
|
|
TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,997.31
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
183257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$6,297.58 |
| Rate for Payer: Aetna Commercial |
$5,947.71
|
| Rate for Payer: Aetna Medicare |
$76.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,548.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.79
|
| Rate for Payer: BCBS Complete |
$40.33
|
| Rate for Payer: BCBS MAPPO |
$73.43
|
| Rate for Payer: BCBS Trust/PPO |
$184.34
|
| Rate for Payer: BCN Commercial |
$184.34
|
| Rate for Payer: BCN Medicare Advantage |
$73.43
|
| Rate for Payer: Cash Price |
$5,597.85
|
| Rate for Payer: Cash Price |
$5,597.85
|
| Rate for Payer: Cofinity Advantage |
$4,898.12
|
| Rate for Payer: Cofinity Commercial |
$6,017.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,597.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.43
|
| Rate for Payer: Healthscope Commercial |
$6,297.58
|
| Rate for Payer: Mclaren Medicaid |
$38.40
|
| Rate for Payer: Mclaren Medicare |
$73.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.10
|
| Rate for Payer: Meridian Medicaid |
$77.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,947.71
|
| Rate for Payer: Nomi Health Commercial |
$220.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,247.98
|
| Rate for Payer: PACE Medicare |
$69.76
|
| Rate for Payer: PACE SWMI |
$73.43
|
| Rate for Payer: PHP Commercial |
$5,947.71
|
| Rate for Payer: PHP Medicare Advantage |
$73.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$236.62
|
| Rate for Payer: Priority Health Medicare |
$73.43
|
| Rate for Payer: Priority Health SBD |
$4,408.31
|
| Rate for Payer: Priority Health Tiered Network |
$189.30
|
| Rate for Payer: Railroad Medicare Medicare |
$73.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.24
|
| Rate for Payer: UHC Core |
$121.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$73.43
|
| Rate for Payer: UHC Exchange |
$121.24
|
| Rate for Payer: UHC Medicaid |
$38.40
|
| Rate for Payer: UHCCP Medicaid |
$38.40
|
| Rate for Payer: VA VA |
$73.43
|
|
|
TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,997.31
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
183257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,408.31 |
| Max. Negotiated Rate |
$6,297.58 |
| Rate for Payer: Aetna Commercial |
$5,947.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,548.25
|
| Rate for Payer: Cash Price |
$5,597.85
|
| Rate for Payer: Cofinity Advantage |
$4,898.12
|
| Rate for Payer: Cofinity Commercial |
$6,017.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,597.85
|
| Rate for Payer: Healthscope Commercial |
$6,297.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,947.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,247.98
|
| Rate for Payer: PHP Commercial |
$5,947.71
|
| Rate for Payer: Priority Health SBD |
$4,408.31
|
|
|
TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16,671.29
|
|
|
Service Code
|
HCPCS Q5117
|
| Hospital Charge Code |
190713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$15,004.16 |
| Rate for Payer: Aetna Commercial |
$14,170.60
|
| Rate for Payer: Aetna Medicare |
$58.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,836.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.47
|
| Rate for Payer: BCBS Complete |
$30.96
|
| Rate for Payer: BCBS MAPPO |
$56.38
|
| Rate for Payer: BCBS Trust/PPO |
$122.04
|
| Rate for Payer: BCN Commercial |
$122.04
|
| Rate for Payer: BCN Medicare Advantage |
$56.38
|
| Rate for Payer: Cash Price |
$13,337.03
|
| Rate for Payer: Cash Price |
$13,337.03
|
| Rate for Payer: Cofinity Advantage |
$11,669.90
|
| Rate for Payer: Cofinity Commercial |
$14,337.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,337.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.38
|
| Rate for Payer: Healthscope Commercial |
$15,004.16
|
| Rate for Payer: Mclaren Medicaid |
$29.49
|
| Rate for Payer: Mclaren Medicare |
$56.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.20
|
| Rate for Payer: Meridian Medicaid |
$59.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,170.60
|
| Rate for Payer: Nomi Health Commercial |
$169.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,503.47
|
| Rate for Payer: PACE Medicare |
$53.56
|
| Rate for Payer: PACE SWMI |
$56.38
|
| Rate for Payer: PHP Commercial |
$14,170.60
|
| Rate for Payer: PHP Medicare Advantage |
$56.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$149.96
|
| Rate for Payer: Priority Health Medicare |
$56.38
|
| Rate for Payer: Priority Health SBD |
$10,502.91
|
| Rate for Payer: Priority Health Tiered Network |
$119.97
|
| Rate for Payer: Railroad Medicare Medicare |
$56.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.88
|
| Rate for Payer: UHC Core |
$84.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56.38
|
| Rate for Payer: UHC Exchange |
$84.88
|
| Rate for Payer: UHC Medicaid |
$29.49
|
| Rate for Payer: UHCCP Medicaid |
$29.49
|
| Rate for Payer: VA VA |
$56.38
|
|
|
TRASTUZUMAB-DKST 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$10,572.29
|
|
|
Service Code
|
HCPCS Q5114
|
| Hospital Charge Code |
192041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.71 |
| Max. Negotiated Rate |
$9,515.06 |
| Rate for Payer: Aetna Commercial |
$8,986.45
|
| Rate for Payer: Aetna Medicare |
$37.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,871.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.73
|
| Rate for Payer: BCBS Complete |
$19.65
|
| Rate for Payer: BCBS MAPPO |
$35.78
|
| Rate for Payer: BCBS Trust/PPO |
$85.52
|
| Rate for Payer: BCN Commercial |
$85.52
|
| Rate for Payer: BCN Medicare Advantage |
$35.78
|
| Rate for Payer: Cash Price |
$8,457.83
|
| Rate for Payer: Cash Price |
$8,457.83
|
| Rate for Payer: Cofinity Advantage |
$7,400.60
|
| Rate for Payer: Cofinity Commercial |
$9,092.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,457.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.78
|
| Rate for Payer: Healthscope Commercial |
$9,515.06
|
| Rate for Payer: Mclaren Medicaid |
$18.71
|
| Rate for Payer: Mclaren Medicare |
$35.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.57
|
| Rate for Payer: Meridian Medicaid |
$37.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,986.45
|
| Rate for Payer: Nomi Health Commercial |
$107.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,929.22
|
| Rate for Payer: PACE Medicare |
$33.99
|
| Rate for Payer: PACE SWMI |
$35.78
|
| Rate for Payer: PHP Commercial |
$8,986.45
|
| Rate for Payer: PHP Medicare Advantage |
$35.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$127.09
|
| Rate for Payer: Priority Health Medicare |
$35.78
|
| Rate for Payer: Priority Health SBD |
$6,660.54
|
| Rate for Payer: Priority Health Tiered Network |
$101.67
|
| Rate for Payer: Railroad Medicare Medicare |
$35.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.22
|
| Rate for Payer: UHC Core |
$62.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.78
|
| Rate for Payer: UHC Exchange |
$62.22
|
| Rate for Payer: UHC Medicaid |
$18.71
|
| Rate for Payer: UHCCP Medicaid |
$18.71
|
| Rate for Payer: VA VA |
$35.78
|
|
|
TRASTUZUMAB-PKRB 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,359.05
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
192874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$8,423.15 |
| Rate for Payer: Aetna Commercial |
$7,955.19
|
| Rate for Payer: Aetna Medicare |
$58.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,083.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.03
|
| Rate for Payer: BCBS Complete |
$30.77
|
| Rate for Payer: BCBS MAPPO |
$56.02
|
| Rate for Payer: BCBS Trust/PPO |
$132.65
|
| Rate for Payer: BCN Commercial |
$132.65
|
| Rate for Payer: BCN Medicare Advantage |
$56.02
|
| Rate for Payer: Cash Price |
$7,487.24
|
| Rate for Payer: Cash Price |
$7,487.24
|
| Rate for Payer: Cofinity Advantage |
$6,551.34
|
| Rate for Payer: Cofinity Commercial |
$8,048.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,487.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.02
|
| Rate for Payer: Healthscope Commercial |
$8,423.15
|
| Rate for Payer: Mclaren Medicaid |
$29.30
|
| Rate for Payer: Mclaren Medicare |
$56.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.82
|
| Rate for Payer: Meridian Medicaid |
$58.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$61.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,955.19
|
| Rate for Payer: Nomi Health Commercial |
$168.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,019.29
|
| Rate for Payer: PACE Medicare |
$53.22
|
| Rate for Payer: PACE SWMI |
$56.02
|
| Rate for Payer: PHP Commercial |
$7,955.19
|
| Rate for Payer: PHP Medicare Advantage |
$56.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$218.78
|
| Rate for Payer: Priority Health Medicare |
$56.02
|
| Rate for Payer: Priority Health SBD |
$5,896.20
|
| Rate for Payer: Priority Health Tiered Network |
$175.02
|
| Rate for Payer: Railroad Medicare Medicare |
$56.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.46
|
| Rate for Payer: UHC Core |
$91.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56.02
|
| Rate for Payer: UHC Exchange |
$91.46
|
| Rate for Payer: UHC Medicaid |
$29.30
|
| Rate for Payer: UHCCP Medicaid |
$29.30
|
| Rate for Payer: VA VA |
$56.02
|
|
|
TRASTUZUMAB-PKRB 420 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,359.05
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
192874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,896.20 |
| Max. Negotiated Rate |
$8,423.15 |
| Rate for Payer: Aetna Commercial |
$7,955.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,083.38
|
| Rate for Payer: Cash Price |
$7,487.24
|
| Rate for Payer: Cofinity Advantage |
$6,551.34
|
| Rate for Payer: Cofinity Commercial |
$8,048.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,487.24
|
| Rate for Payer: Healthscope Commercial |
$8,423.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,955.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,019.29
|
| Rate for Payer: PHP Commercial |
$7,955.19
|
| Rate for Payer: Priority Health SBD |
$5,896.20
|
|
|
TRASTUZUMAB-QYYP 150 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,923.37
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
196476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$3,531.03 |
| Rate for Payer: Aetna Commercial |
$3,334.86
|
| Rate for Payer: Aetna Medicare |
$10.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,550.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.04
|
| Rate for Payer: BCBS Complete |
$5.73
|
| Rate for Payer: BCBS MAPPO |
$10.43
|
| Rate for Payer: BCBS Trust/PPO |
$97.22
|
| Rate for Payer: BCN Commercial |
$97.22
|
| Rate for Payer: BCN Medicare Advantage |
$10.43
|
| Rate for Payer: Cash Price |
$3,138.70
|
| Rate for Payer: Cash Price |
$3,138.70
|
| Rate for Payer: Cofinity Advantage |
$2,746.36
|
| Rate for Payer: Cofinity Commercial |
$3,374.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,138.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.43
|
| Rate for Payer: Healthscope Commercial |
$3,531.03
|
| Rate for Payer: Mclaren Medicaid |
$5.45
|
| Rate for Payer: Mclaren Medicare |
$10.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.95
|
| Rate for Payer: Meridian Medicaid |
$10.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,334.86
|
| Rate for Payer: Nomi Health Commercial |
$31.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,942.53
|
| Rate for Payer: PACE Medicare |
$9.91
|
| Rate for Payer: PACE SWMI |
$10.43
|
| Rate for Payer: PHP Commercial |
$3,334.86
|
| Rate for Payer: PHP Medicare Advantage |
$10.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$88.28
|
| Rate for Payer: Priority Health Medicare |
$10.43
|
| Rate for Payer: Priority Health SBD |
$2,471.72
|
| Rate for Payer: Priority Health Tiered Network |
$70.62
|
| Rate for Payer: Railroad Medicare Medicare |
$10.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.55
|
| Rate for Payer: UHC Core |
$13.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.43
|
| Rate for Payer: UHC Exchange |
$13.55
|
| Rate for Payer: UHC Medicaid |
$5.45
|
| Rate for Payer: UHCCP Medicaid |
$5.45
|
| Rate for Payer: VA VA |
$10.43
|
|
|
TRASTUZUMAB-QYYP 150 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,923.37
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
196476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,471.72 |
| Max. Negotiated Rate |
$3,531.03 |
| Rate for Payer: Aetna Commercial |
$3,334.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,550.19
|
| Rate for Payer: Cash Price |
$3,138.70
|
| Rate for Payer: Cofinity Advantage |
$2,746.36
|
| Rate for Payer: Cofinity Commercial |
$3,374.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,138.70
|
| Rate for Payer: Healthscope Commercial |
$3,531.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,334.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,942.53
|
| Rate for Payer: PHP Commercial |
$3,334.86
|
| Rate for Payer: Priority Health SBD |
$2,471.72
|
|
|
TRASTUZUMAB-QYYP 420 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$10,985.55
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
192875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,920.90 |
| Max. Negotiated Rate |
$9,887.00 |
| Rate for Payer: Aetna Commercial |
$9,337.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,140.61
|
| Rate for Payer: Cash Price |
$8,788.44
|
| Rate for Payer: Cofinity Advantage |
$7,689.89
|
| Rate for Payer: Cofinity Commercial |
$9,447.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,788.44
|
| Rate for Payer: Healthscope Commercial |
$9,887.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,337.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,239.16
|
| Rate for Payer: PHP Commercial |
$9,337.72
|
| Rate for Payer: Priority Health SBD |
$6,920.90
|
|
|
TRASTUZUMAB-QYYP 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$10,985.55
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
192875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$9,887.00 |
| Rate for Payer: Aetna Commercial |
$9,337.72
|
| Rate for Payer: Aetna Medicare |
$10.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,140.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.04
|
| Rate for Payer: BCBS Complete |
$5.73
|
| Rate for Payer: BCBS MAPPO |
$10.43
|
| Rate for Payer: BCBS Trust/PPO |
$97.22
|
| Rate for Payer: BCN Commercial |
$97.22
|
| Rate for Payer: BCN Medicare Advantage |
$10.43
|
| Rate for Payer: Cash Price |
$8,788.44
|
| Rate for Payer: Cash Price |
$8,788.44
|
| Rate for Payer: Cofinity Advantage |
$7,689.89
|
| Rate for Payer: Cofinity Commercial |
$9,447.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,788.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.43
|
| Rate for Payer: Healthscope Commercial |
$9,887.00
|
| Rate for Payer: Mclaren Medicaid |
$5.45
|
| Rate for Payer: Mclaren Medicare |
$10.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.95
|
| Rate for Payer: Meridian Medicaid |
$10.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,337.72
|
| Rate for Payer: Nomi Health Commercial |
$31.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,239.16
|
| Rate for Payer: PACE Medicare |
$9.91
|
| Rate for Payer: PACE SWMI |
$10.43
|
| Rate for Payer: PHP Commercial |
$9,337.72
|
| Rate for Payer: PHP Medicare Advantage |
$10.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$88.28
|
| Rate for Payer: Priority Health Medicare |
$10.43
|
| Rate for Payer: Priority Health SBD |
$6,920.90
|
| Rate for Payer: Priority Health Tiered Network |
$70.62
|
| Rate for Payer: Railroad Medicare Medicare |
$10.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.55
|
| Rate for Payer: UHC Core |
$13.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.43
|
| Rate for Payer: UHC Exchange |
$13.55
|
| Rate for Payer: UHC Medicaid |
$5.45
|
| Rate for Payer: UHCCP Medicaid |
$5.45
|
| Rate for Payer: VA VA |
$10.43
|
|
|
TRAUMATIC INJURY WITH MCC
|
Facility
|
IP
|
$26,643.98
|
|
|
Service Code
|
MSDRG 913
|
| Min. Negotiated Rate |
$12,550.99 |
| Max. Negotiated Rate |
$26,643.98 |
| Rate for Payer: Aetna Medicare |
$13,740.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,514.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,514.46
|
| Rate for Payer: BCBS MAPPO |
$13,211.57
|
| Rate for Payer: BCBS Trust/PPO |
$20,767.58
|
| Rate for Payer: BCN Commercial |
$20,767.58
|
| Rate for Payer: BCN Medicare Advantage |
$13,211.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,211.57
|
| Rate for Payer: Mclaren Medicare |
$13,211.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,872.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,193.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,532.73
|
| Rate for Payer: Nomi Health Commercial |
$21,086.34
|
| Rate for Payer: PACE Medicare |
$12,550.99
|
| Rate for Payer: PACE SWMI |
$13,211.57
|
| Rate for Payer: PHP Medicare Advantage |
$13,211.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,353.25
|
| Rate for Payer: Priority Health Medicare |
$13,211.57
|
| Rate for Payer: Priority Health Tiered Network |
$21,082.60
|
| Rate for Payer: Railroad Medicare Medicare |
$13,211.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,643.98
|
| Rate for Payer: UHC Core |
$22,291.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,211.57
|
| Rate for Payer: UHC Exchange |
$18,204.54
|
| Rate for Payer: VA VA |
$13,211.57
|
|
|
TRAUMATIC INJURY WITHOUT MCC
|
Facility
|
IP
|
$16,558.82
|
|
|
Service Code
|
MSDRG 914
|
| Min. Negotiated Rate |
$7,051.23 |
| Max. Negotiated Rate |
$16,558.82 |
| Rate for Payer: Aetna Medicare |
$7,719.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,277.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,277.94
|
| Rate for Payer: BCBS MAPPO |
$7,422.35
|
| Rate for Payer: BCBS Trust/PPO |
$16,558.82
|
| Rate for Payer: BCN Commercial |
$16,558.82
|
| Rate for Payer: BCN Medicare Advantage |
$7,422.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,422.35
|
| Rate for Payer: Mclaren Medicare |
$7,422.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,793.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,535.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,164.59
|
| Rate for Payer: Nomi Health Commercial |
$11,422.95
|
| Rate for Payer: PACE Medicare |
$7,051.23
|
| Rate for Payer: PACE SWMI |
$7,422.35
|
| Rate for Payer: PHP Medicare Advantage |
$7,422.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,276.15
|
| Rate for Payer: Priority Health Medicare |
$7,422.35
|
| Rate for Payer: Priority Health Tiered Network |
$11,420.92
|
| Rate for Payer: Railroad Medicare Medicare |
$7,422.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,433.65
|
| Rate for Payer: UHC Core |
$12,075.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,422.35
|
| Rate for Payer: UHC Exchange |
$9,861.81
|
| Rate for Payer: VA VA |
$7,422.35
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC
|
Facility
|
IP
|
$21,234.01
|
|
|
Service Code
|
MSDRG 086
|
| Min. Negotiated Rate |
$10,114.23 |
| Max. Negotiated Rate |
$21,234.01 |
| Rate for Payer: Aetna Medicare |
$11,072.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,308.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,308.20
|
| Rate for Payer: BCBS MAPPO |
$10,646.56
|
| Rate for Payer: BCBS Trust/PPO |
$20,526.48
|
| Rate for Payer: BCN Commercial |
$20,526.48
|
| Rate for Payer: BCN Medicare Advantage |
$10,646.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,646.56
|
| Rate for Payer: Mclaren Medicare |
$10,646.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,178.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,243.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,711.22
|
| Rate for Payer: Nomi Health Commercial |
$16,804.83
|
| Rate for Payer: PACE Medicare |
$10,114.23
|
| Rate for Payer: PACE SWMI |
$10,646.56
|
| Rate for Payer: PHP Medicare Advantage |
$10,646.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,002.31
|
| Rate for Payer: Priority Health Medicare |
$10,646.56
|
| Rate for Payer: Priority Health Tiered Network |
$16,801.85
|
| Rate for Payer: Railroad Medicare Medicare |
$10,646.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,234.01
|
| Rate for Payer: UHC Core |
$17,764.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,646.56
|
| Rate for Payer: UHC Exchange |
$14,508.17
|
| Rate for Payer: VA VA |
$10,646.56
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC
|
Facility
|
IP
|
$25,336.82
|
|
|
Service Code
|
MSDRG 083
|
| Min. Negotiated Rate |
$10,797.76 |
| Max. Negotiated Rate |
$25,336.82 |
| Rate for Payer: Aetna Medicare |
$11,820.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,207.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,207.58
|
| Rate for Payer: BCBS MAPPO |
$11,366.06
|
| Rate for Payer: BCBS Trust/PPO |
$25,336.82
|
| Rate for Payer: BCN Commercial |
$25,336.82
|
| Rate for Payer: BCN Medicare Advantage |
$11,366.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,366.06
|
| Rate for Payer: Mclaren Medicare |
$11,366.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,934.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,070.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,502.67
|
| Rate for Payer: Nomi Health Commercial |
$18,005.82
|
| Rate for Payer: PACE Medicare |
$10,797.76
|
| Rate for Payer: PACE SWMI |
$11,366.06
|
| Rate for Payer: PHP Medicare Advantage |
$11,366.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,503.28
|
| Rate for Payer: Priority Health Medicare |
$11,366.06
|
| Rate for Payer: Priority Health Tiered Network |
$18,002.62
|
| Rate for Payer: Railroad Medicare Medicare |
$11,366.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,751.54
|
| Rate for Payer: UHC Core |
$19,034.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,366.06
|
| Rate for Payer: UHC Exchange |
$15,545.02
|
| Rate for Payer: VA VA |
$11,366.06
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC
|
Facility
|
IP
|
$38,948.57
|
|
|
Service Code
|
MSDRG 085
|
| Min. Negotiated Rate |
$17,229.92 |
| Max. Negotiated Rate |
$38,948.57 |
| Rate for Payer: Aetna Medicare |
$18,862.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,670.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,670.95
|
| Rate for Payer: BCBS MAPPO |
$18,136.76
|
| Rate for Payer: BCBS Trust/PPO |
$38,948.57
|
| Rate for Payer: BCN Commercial |
$38,948.57
|
| Rate for Payer: BCN Medicare Advantage |
$18,136.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,136.76
|
| Rate for Payer: Mclaren Medicare |
$18,136.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,043.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,857.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,950.44
|
| Rate for Payer: Nomi Health Commercial |
$29,307.51
|
| Rate for Payer: PACE Medicare |
$17,229.92
|
| Rate for Payer: PACE SWMI |
$18,136.76
|
| Rate for Payer: PHP Medicare Advantage |
$18,136.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$36,627.89
|
| Rate for Payer: Priority Health Medicare |
$18,136.76
|
| Rate for Payer: Priority Health Tiered Network |
$29,302.31
|
| Rate for Payer: Railroad Medicare Medicare |
$18,136.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,031.97
|
| Rate for Payer: UHC Core |
$30,981.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,136.76
|
| Rate for Payer: UHC Exchange |
$25,302.15
|
| Rate for Payer: VA VA |
$18,136.76
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC
|
Facility
|
IP
|
$47,274.80
|
|
|
Service Code
|
MSDRG 082
|
| Min. Negotiated Rate |
$17,330.51 |
| Max. Negotiated Rate |
$47,274.80 |
| Rate for Payer: Aetna Medicare |
$18,972.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,803.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,803.30
|
| Rate for Payer: BCBS MAPPO |
$18,242.64
|
| Rate for Payer: BCBS Trust/PPO |
$47,274.80
|
| Rate for Payer: BCN Commercial |
$47,274.80
|
| Rate for Payer: BCN Medicare Advantage |
$18,242.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,242.64
|
| Rate for Payer: Mclaren Medicare |
$18,242.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,154.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,979.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,066.90
|
| Rate for Payer: Nomi Health Commercial |
$29,484.24
|
| Rate for Payer: PACE Medicare |
$17,330.51
|
| Rate for Payer: PACE SWMI |
$18,242.64
|
| Rate for Payer: PHP Medicare Advantage |
$18,242.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$36,848.76
|
| Rate for Payer: Priority Health Medicare |
$18,242.64
|
| Rate for Payer: Priority Health Tiered Network |
$29,479.01
|
| Rate for Payer: Railroad Medicare Medicare |
$18,242.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,255.28
|
| Rate for Payer: UHC Core |
$31,168.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,242.64
|
| Rate for Payer: UHC Exchange |
$25,454.73
|
| Rate for Payer: VA VA |
$18,242.64
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$14,909.61
|
|
|
Service Code
|
MSDRG 087
|
| Min. Negotiated Rate |
$7,265.62 |
| Max. Negotiated Rate |
$14,909.61 |
| Rate for Payer: Aetna Medicare |
$7,953.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,560.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,560.02
|
| Rate for Payer: BCBS MAPPO |
$7,648.02
|
| Rate for Payer: BCBS Trust/PPO |
$14,281.22
|
| Rate for Payer: BCN Commercial |
$14,281.22
|
| Rate for Payer: BCN Medicare Advantage |
$7,648.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,648.02
|
| Rate for Payer: Mclaren Medicare |
$7,648.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,030.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,795.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,412.82
|
| Rate for Payer: Nomi Health Commercial |
$11,799.63
|
| Rate for Payer: PACE Medicare |
$7,265.62
|
| Rate for Payer: PACE SWMI |
$7,648.02
|
| Rate for Payer: PHP Medicare Advantage |
$7,648.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,746.92
|
| Rate for Payer: Priority Health Medicare |
$7,648.02
|
| Rate for Payer: Priority Health Tiered Network |
$11,797.54
|
| Rate for Payer: Railroad Medicare Medicare |
$7,648.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,909.61
|
| Rate for Payer: UHC Core |
$12,473.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,648.02
|
| Rate for Payer: UHC Exchange |
$10,187.01
|
| Rate for Payer: VA VA |
$7,648.02
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$16,247.49
|
|
|
Service Code
|
MSDRG 084
|
| Min. Negotiated Rate |
$7,567.36 |
| Max. Negotiated Rate |
$16,247.49 |
| Rate for Payer: Aetna Medicare |
$8,284.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,957.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,957.05
|
| Rate for Payer: BCBS MAPPO |
$7,965.64
|
| Rate for Payer: BCBS Trust/PPO |
$16,247.49
|
| Rate for Payer: BCN Commercial |
$16,247.49
|
| Rate for Payer: BCN Medicare Advantage |
$7,965.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,965.64
|
| Rate for Payer: Mclaren Medicare |
$7,965.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,363.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,160.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,762.20
|
| Rate for Payer: Nomi Health Commercial |
$12,329.82
|
| Rate for Payer: PACE Medicare |
$7,567.36
|
| Rate for Payer: PACE SWMI |
$7,965.64
|
| Rate for Payer: PHP Medicare Advantage |
$7,965.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,409.54
|
| Rate for Payer: Priority Health Medicare |
$7,965.64
|
| Rate for Payer: Priority Health Tiered Network |
$12,327.63
|
| Rate for Payer: Railroad Medicare Medicare |
$7,965.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,579.54
|
| Rate for Payer: UHC Core |
$13,034.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,965.64
|
| Rate for Payer: UHC Exchange |
$10,644.74
|
| Rate for Payer: VA VA |
$7,965.64
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC
|
Facility
|
IP
|
$23,995.23
|
|
|
Service Code
|
MSDRG 604
|
| Min. Negotiated Rate |
$11,357.94 |
| Max. Negotiated Rate |
$23,995.23 |
| Rate for Payer: Aetna Medicare |
$12,433.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,944.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,944.66
|
| Rate for Payer: BCBS MAPPO |
$11,955.73
|
| Rate for Payer: BCBS Trust/PPO |
$15,407.15
|
| Rate for Payer: BCN Commercial |
$15,407.15
|
| Rate for Payer: BCN Medicare Advantage |
$11,955.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,955.73
|
| Rate for Payer: Mclaren Medicare |
$11,955.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,553.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,749.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,151.30
|
| Rate for Payer: Nomi Health Commercial |
$18,990.09
|
| Rate for Payer: PACE Medicare |
$11,357.94
|
| Rate for Payer: PACE SWMI |
$11,955.73
|
| Rate for Payer: PHP Medicare Advantage |
$11,955.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,733.40
|
| Rate for Payer: Priority Health Medicare |
$11,955.73
|
| Rate for Payer: Priority Health Tiered Network |
$18,986.72
|
| Rate for Payer: Railroad Medicare Medicare |
$11,955.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,995.23
|
| Rate for Payer: UHC Core |
$20,075.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,955.73
|
| Rate for Payer: UHC Exchange |
$16,394.78
|
| Rate for Payer: VA VA |
$11,955.73
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC
|
Facility
|
IP
|
$14,930.80
|
|
|
Service Code
|
MSDRG 605
|
| Min. Negotiated Rate |
$7,275.16 |
| Max. Negotiated Rate |
$14,930.80 |
| Rate for Payer: Aetna Medicare |
$7,964.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,572.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,572.58
|
| Rate for Payer: BCBS MAPPO |
$7,658.06
|
| Rate for Payer: BCBS Trust/PPO |
$13,270.00
|
| Rate for Payer: BCN Commercial |
$13,270.00
|
| Rate for Payer: BCN Medicare Advantage |
$7,658.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,658.06
|
| Rate for Payer: Mclaren Medicare |
$7,658.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,040.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,806.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,423.87
|
| Rate for Payer: Nomi Health Commercial |
$11,816.40
|
| Rate for Payer: PACE Medicare |
$7,275.16
|
| Rate for Payer: PACE SWMI |
$7,658.06
|
| Rate for Payer: PHP Medicare Advantage |
$7,658.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,767.88
|
| Rate for Payer: Priority Health Medicare |
$7,658.06
|
| Rate for Payer: Priority Health Tiered Network |
$11,814.30
|
| Rate for Payer: Railroad Medicare Medicare |
$7,658.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,930.80
|
| Rate for Payer: UHC Core |
$12,491.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,658.06
|
| Rate for Payer: UHC Exchange |
$10,201.49
|
| Rate for Payer: VA VA |
$7,658.06
|
|
|
TRAZODONE 100 MG TABLET
|
Facility
|
IP
|
$430.05
|
|
|
Service Code
|
NDC 60687045401
|
| Hospital Charge Code |
8083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.93 |
| Max. Negotiated Rate |
$387.05 |
| Rate for Payer: Aetna Commercial |
$365.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.53
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cofinity Advantage |
$301.04
|
| Rate for Payer: Cofinity Commercial |
$369.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Healthscope Commercial |
$387.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.54
|
| Rate for Payer: PHP Commercial |
$365.54
|
| Rate for Payer: Priority Health SBD |
$270.93
|
|
|
TRAZODONE 100 MG TABLET
|
Facility
|
IP
|
$390.10
|
|
|
Service Code
|
NDC 00904686961
|
| Hospital Charge Code |
8083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.76 |
| Max. Negotiated Rate |
$351.09 |
| Rate for Payer: Aetna Commercial |
$331.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.56
|
| Rate for Payer: Cash Price |
$312.08
|
| Rate for Payer: Cofinity Advantage |
$273.07
|
| Rate for Payer: Cofinity Commercial |
$335.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.08
|
| Rate for Payer: Healthscope Commercial |
$351.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.57
|
| Rate for Payer: PHP Commercial |
$331.58
|
| Rate for Payer: Priority Health SBD |
$245.76
|
|
|
TRAZODONE 100 MG TABLET
|
Facility
|
OP
|
$390.10
|
|
|
Service Code
|
NDC 00904686961
|
| Hospital Charge Code |
8083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.31 |
| Max. Negotiated Rate |
$351.09 |
| Rate for Payer: Aetna Commercial |
$331.58
|
| Rate for Payer: Aetna Medicare |
$195.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.56
|
| Rate for Payer: BCBS Complete |
$156.04
|
| Rate for Payer: Cash Price |
$312.08
|
| Rate for Payer: Cofinity Advantage |
$273.07
|
| Rate for Payer: Cofinity Commercial |
$335.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.08
|
| Rate for Payer: Healthscope Commercial |
$351.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$312.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.57
|
| Rate for Payer: PHP Commercial |
$331.58
|
| Rate for Payer: Priority Health SBD |
$245.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.56
|
| Rate for Payer: UHC Core |
$203.24
|
| Rate for Payer: UHC Exchange |
$153.31
|
|
