|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$1.65
|
|
|
Service Code
|
NDC 60687068111
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna Commercial |
$1.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.07
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Cofinity Advantage |
$1.16
|
| Rate for Payer: Cofinity Commercial |
$1.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.32
|
| Rate for Payer: Healthscope Commercial |
$1.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.24
|
| Rate for Payer: PHP Commercial |
$1.40
|
| Rate for Payer: Priority Health SBD |
$1.04
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
NDC 69315012701
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.02 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna Commercial |
$142.80
|
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.20
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Advantage |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$144.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Healthscope Commercial |
$151.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: PHP Commercial |
$142.80
|
| Rate for Payer: Priority Health SBD |
$105.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.20
|
| Rate for Payer: UHC Core |
$87.53
|
| Rate for Payer: UHC Exchange |
$66.02
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
NDC 60687068101
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.95 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna Commercial |
$140.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.25
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Advantage |
$115.50
|
| Rate for Payer: Cofinity Commercial |
$141.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.00
|
| Rate for Payer: Healthscope Commercial |
$148.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.75
|
| Rate for Payer: PHP Commercial |
$140.25
|
| Rate for Payer: Priority Health SBD |
$103.95
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$149.60
|
|
|
Service Code
|
NDC 00904722461
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.25 |
| Max. Negotiated Rate |
$134.64 |
| Rate for Payer: Aetna Commercial |
$127.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.24
|
| Rate for Payer: Cash Price |
$119.68
|
| Rate for Payer: Cofinity Advantage |
$104.72
|
| Rate for Payer: Cofinity Commercial |
$128.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.68
|
| Rate for Payer: Healthscope Commercial |
$134.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.20
|
| Rate for Payer: PHP Commercial |
$127.16
|
| Rate for Payer: Priority Health SBD |
$94.25
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
NDC 11534016501
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.12 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$190.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Advantage |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$192.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.20
|
| Rate for Payer: Healthscope Commercial |
$201.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.00
|
| Rate for Payer: PHP Commercial |
$190.40
|
| Rate for Payer: Priority Health SBD |
$141.12
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
NDC 60687068101
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.84 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna Commercial |
$140.25
|
| Rate for Payer: Aetna Medicare |
$82.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.25
|
| Rate for Payer: BCBS Complete |
$66.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Advantage |
$115.50
|
| Rate for Payer: Cofinity Commercial |
$141.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.00
|
| Rate for Payer: Healthscope Commercial |
$148.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.75
|
| Rate for Payer: PHP Commercial |
$140.25
|
| Rate for Payer: Priority Health SBD |
$103.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.25
|
| Rate for Payer: UHC Core |
$85.97
|
| Rate for Payer: UHC Exchange |
$64.84
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$149.60
|
|
|
Service Code
|
NDC 00904722461
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.79 |
| Max. Negotiated Rate |
$134.64 |
| Rate for Payer: Aetna Commercial |
$127.16
|
| Rate for Payer: Aetna Medicare |
$74.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.24
|
| Rate for Payer: BCBS Complete |
$59.84
|
| Rate for Payer: Cash Price |
$119.68
|
| Rate for Payer: Cofinity Advantage |
$104.72
|
| Rate for Payer: Cofinity Commercial |
$128.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.68
|
| Rate for Payer: Healthscope Commercial |
$134.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.20
|
| Rate for Payer: PHP Commercial |
$127.16
|
| Rate for Payer: Priority Health SBD |
$94.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.24
|
| Rate for Payer: UHC Core |
$77.94
|
| Rate for Payer: UHC Exchange |
$58.79
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 65162036110
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.88 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Advantage |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health SBD |
$118.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.20
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: UHC Exchange |
$73.88
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 65162036110
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.44 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Advantage |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health SBD |
$118.44
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
NDC 11534016501
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.03 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$190.40
|
| Rate for Payer: Aetna Medicare |
$112.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.60
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Advantage |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$192.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.20
|
| Rate for Payer: Healthscope Commercial |
$201.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.00
|
| Rate for Payer: PHP Commercial |
$190.40
|
| Rate for Payer: Priority Health SBD |
$141.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.60
|
| Rate for Payer: UHC Core |
$116.70
|
| Rate for Payer: UHC Exchange |
$88.03
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$158.51
|
|
|
Service Code
|
HCPCS J1808
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.86 |
| Max. Negotiated Rate |
$142.66 |
| Rate for Payer: Aetna Commercial |
$134.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.03
|
| Rate for Payer: Cash Price |
$126.81
|
| Rate for Payer: Cofinity Advantage |
$110.96
|
| Rate for Payer: Cofinity Commercial |
$136.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.81
|
| Rate for Payer: Healthscope Commercial |
$142.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.88
|
| Rate for Payer: PHP Commercial |
$134.73
|
| Rate for Payer: Priority Health SBD |
$99.86
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$158.51
|
|
|
Service Code
|
HCPCS J1808
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$142.66 |
| Rate for Payer: Aetna Commercial |
$134.73
|
| Rate for Payer: Aetna Medicare |
$79.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.03
|
| Rate for Payer: BCBS Complete |
$63.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$126.81
|
| Rate for Payer: Cash Price |
$126.81
|
| Rate for Payer: Cofinity Advantage |
$110.96
|
| Rate for Payer: Cofinity Commercial |
$136.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.81
|
| Rate for Payer: Healthscope Commercial |
$142.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.88
|
| Rate for Payer: PHP Commercial |
$134.73
|
| Rate for Payer: Priority Health SBD |
$99.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
|
|
FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,493.96
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
22185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$941.19 |
| Max. Negotiated Rate |
$1,344.56 |
| Rate for Payer: Aetna Commercial |
$1,269.87
|
| Rate for Payer: Aetna Commercial |
$2,494.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$971.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,907.30
|
| Rate for Payer: Cash Price |
$1,195.17
|
| Rate for Payer: Cash Price |
$2,347.45
|
| Rate for Payer: Cofinity Advantage |
$1,045.77
|
| Rate for Payer: Cofinity Advantage |
$2,054.02
|
| Rate for Payer: Cofinity Commercial |
$1,284.81
|
| Rate for Payer: Cofinity Commercial |
$2,523.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,347.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,195.17
|
| Rate for Payer: Healthscope Commercial |
$2,640.88
|
| Rate for Payer: Healthscope Commercial |
$1,344.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,269.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,494.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,120.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,200.73
|
| Rate for Payer: PHP Commercial |
$1,269.87
|
| Rate for Payer: PHP Commercial |
$2,494.16
|
| Rate for Payer: Priority Health SBD |
$941.19
|
| Rate for Payer: Priority Health SBD |
$1,848.62
|
|
|
FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,493.96
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
22185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$1,344.56 |
| Rate for Payer: Aetna Commercial |
$1,269.87
|
| Rate for Payer: Aetna Commercial |
$2,494.16
|
| Rate for Payer: Aetna Medicare |
$6.80
|
| Rate for Payer: Aetna Medicare |
$6.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,907.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$971.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.18
|
| Rate for Payer: BCBS Complete |
$3.59
|
| Rate for Payer: BCBS Complete |
$3.59
|
| Rate for Payer: BCBS MAPPO |
$6.54
|
| Rate for Payer: BCBS MAPPO |
$6.54
|
| Rate for Payer: BCBS Trust/PPO |
$25.04
|
| Rate for Payer: BCBS Trust/PPO |
$25.04
|
| Rate for Payer: BCN Commercial |
$25.04
|
| Rate for Payer: BCN Commercial |
$25.04
|
| Rate for Payer: BCN Medicare Advantage |
$6.54
|
| Rate for Payer: BCN Medicare Advantage |
$6.54
|
| Rate for Payer: Cash Price |
$1,195.17
|
| Rate for Payer: Cash Price |
$2,347.45
|
| Rate for Payer: Cash Price |
$2,347.45
|
| Rate for Payer: Cash Price |
$1,195.17
|
| Rate for Payer: Cofinity Advantage |
$2,054.02
|
| Rate for Payer: Cofinity Advantage |
$1,045.77
|
| Rate for Payer: Cofinity Commercial |
$2,523.51
|
| Rate for Payer: Cofinity Commercial |
$1,284.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,195.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,347.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.54
|
| Rate for Payer: Healthscope Commercial |
$1,344.56
|
| Rate for Payer: Healthscope Commercial |
$2,640.88
|
| Rate for Payer: Mclaren Medicaid |
$3.42
|
| Rate for Payer: Mclaren Medicaid |
$3.42
|
| Rate for Payer: Mclaren Medicare |
$6.54
|
| Rate for Payer: Mclaren Medicare |
$6.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.87
|
| Rate for Payer: Meridian Medicaid |
$6.87
|
| Rate for Payer: Meridian Medicaid |
$6.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,269.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,494.16
|
| Rate for Payer: Nomi Health Commercial |
$19.62
|
| Rate for Payer: Nomi Health Commercial |
$19.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,120.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,200.73
|
| Rate for Payer: PACE Medicare |
$6.21
|
| Rate for Payer: PACE Medicare |
$6.21
|
| Rate for Payer: PACE SWMI |
$6.54
|
| Rate for Payer: PACE SWMI |
$6.54
|
| Rate for Payer: PHP Commercial |
$2,494.16
|
| Rate for Payer: PHP Commercial |
$1,269.87
|
| Rate for Payer: PHP Medicare Advantage |
$6.54
|
| Rate for Payer: PHP Medicare Advantage |
$6.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19.81
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health SBD |
$1,848.62
|
| Rate for Payer: Priority Health SBD |
$941.19
|
| Rate for Payer: Priority Health Tiered Network |
$15.85
|
| Rate for Payer: Priority Health Tiered Network |
$15.85
|
| Rate for Payer: Railroad Medicare Medicare |
$6.54
|
| Rate for Payer: Railroad Medicare Medicare |
$6.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.61
|
| Rate for Payer: UHC Core |
$10.61
|
| Rate for Payer: UHC Core |
$10.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.54
|
| Rate for Payer: UHC Exchange |
$10.61
|
| Rate for Payer: UHC Exchange |
$10.61
|
| Rate for Payer: UHC Medicaid |
$3.42
|
| Rate for Payer: UHC Medicaid |
$3.42
|
| Rate for Payer: UHCCP Medicaid |
$3.42
|
| Rate for Payer: UHCCP Medicaid |
$3.42
|
| Rate for Payer: VA VA |
$6.54
|
| Rate for Payer: VA VA |
$6.54
|
|
|
FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
IP
|
$43.46
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
115590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.38 |
| Max. Negotiated Rate |
$39.11 |
| Rate for Payer: Aetna Commercial |
$36.94
|
| Rate for Payer: Aetna Commercial |
$142.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.25
|
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Cofinity Advantage |
$117.61
|
| Rate for Payer: Cofinity Advantage |
$30.42
|
| Rate for Payer: Cofinity Commercial |
$144.50
|
| Rate for Payer: Cofinity Commercial |
$37.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.42
|
| Rate for Payer: Healthscope Commercial |
$39.11
|
| Rate for Payer: Healthscope Commercial |
$151.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.59
|
| Rate for Payer: PHP Commercial |
$142.82
|
| Rate for Payer: PHP Commercial |
$36.94
|
| Rate for Payer: Priority Health SBD |
$105.85
|
| Rate for Payer: Priority Health SBD |
$27.38
|
|
|
FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
OP
|
$168.02
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
115590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$151.22 |
| Rate for Payer: Aetna Commercial |
$142.82
|
| Rate for Payer: Aetna Commercial |
$36.94
|
| Rate for Payer: Aetna Medicare |
$21.73
|
| Rate for Payer: Aetna Medicare |
$84.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.21
|
| Rate for Payer: BCBS Complete |
$67.21
|
| Rate for Payer: BCBS Complete |
$17.38
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.19
|
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Cofinity Advantage |
$117.61
|
| Rate for Payer: Cofinity Advantage |
$30.42
|
| Rate for Payer: Cofinity Commercial |
$144.50
|
| Rate for Payer: Cofinity Commercial |
$37.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.42
|
| Rate for Payer: Healthscope Commercial |
$151.22
|
| Rate for Payer: Healthscope Commercial |
$39.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.59
|
| Rate for Payer: PHP Commercial |
$36.94
|
| Rate for Payer: PHP Commercial |
$142.82
|
| Rate for Payer: Priority Health SBD |
$105.85
|
| Rate for Payer: Priority Health SBD |
$27.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.21
|
| Rate for Payer: UHC Core |
$87.54
|
| Rate for Payer: UHC Core |
$22.64
|
| Rate for Payer: UHC Exchange |
$66.03
|
| Rate for Payer: UHC Exchange |
$17.08
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
OP
|
$50.71
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
32215
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$45.64 |
| Rate for Payer: Aetna Commercial |
$43.10
|
| Rate for Payer: Aetna Commercial |
$23.10
|
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: Aetna Commercial |
$21.49
|
| Rate for Payer: Aetna Medicare |
$12.64
|
| Rate for Payer: Aetna Medicare |
$25.36
|
| Rate for Payer: Aetna Medicare |
$13.59
|
| Rate for Payer: Aetna Medicare |
$16.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.40
|
| Rate for Payer: BCBS Complete |
$13.17
|
| Rate for Payer: BCBS Complete |
$10.87
|
| Rate for Payer: BCBS Complete |
$20.28
|
| Rate for Payer: BCBS Complete |
$10.11
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.19
|
| Rate for Payer: Cash Price |
$21.74
|
| Rate for Payer: Cash Price |
$20.22
|
| Rate for Payer: Cash Price |
$20.22
|
| Rate for Payer: Cash Price |
$40.57
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cash Price |
$21.74
|
| Rate for Payer: Cash Price |
$40.57
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cofinity Advantage |
$35.50
|
| Rate for Payer: Cofinity Advantage |
$19.03
|
| Rate for Payer: Cofinity Advantage |
$17.70
|
| Rate for Payer: Cofinity Advantage |
$23.05
|
| Rate for Payer: Cofinity Commercial |
$28.32
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Cofinity Commercial |
$21.74
|
| Rate for Payer: Cofinity Commercial |
$43.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.22
|
| Rate for Payer: Healthscope Commercial |
$29.64
|
| Rate for Payer: Healthscope Commercial |
$24.46
|
| Rate for Payer: Healthscope Commercial |
$22.75
|
| Rate for Payer: Healthscope Commercial |
$45.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.39
|
| Rate for Payer: PHP Commercial |
$23.10
|
| Rate for Payer: PHP Commercial |
$27.99
|
| Rate for Payer: PHP Commercial |
$21.49
|
| Rate for Payer: PHP Commercial |
$43.10
|
| Rate for Payer: Priority Health SBD |
$31.95
|
| Rate for Payer: Priority Health SBD |
$20.75
|
| Rate for Payer: Priority Health SBD |
$17.12
|
| Rate for Payer: Priority Health SBD |
$15.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.96
|
| Rate for Payer: UHC Core |
$13.17
|
| Rate for Payer: UHC Core |
$17.16
|
| Rate for Payer: UHC Core |
$26.42
|
| Rate for Payer: UHC Core |
$14.16
|
| Rate for Payer: UHC Exchange |
$9.94
|
| Rate for Payer: UHC Exchange |
$10.68
|
| Rate for Payer: UHC Exchange |
$12.94
|
| Rate for Payer: UHC Exchange |
$19.93
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
IP
|
$50.71
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
32215
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$45.64 |
| Rate for Payer: Aetna Commercial |
$43.10
|
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: Aetna Commercial |
$21.49
|
| Rate for Payer: Aetna Commercial |
$23.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.96
|
| Rate for Payer: Cash Price |
$20.22
|
| Rate for Payer: Cash Price |
$21.74
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cash Price |
$40.57
|
| Rate for Payer: Cofinity Advantage |
$19.03
|
| Rate for Payer: Cofinity Advantage |
$23.05
|
| Rate for Payer: Cofinity Advantage |
$35.50
|
| Rate for Payer: Cofinity Advantage |
$17.70
|
| Rate for Payer: Cofinity Commercial |
$28.32
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Cofinity Commercial |
$43.61
|
| Rate for Payer: Cofinity Commercial |
$21.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.57
|
| Rate for Payer: Healthscope Commercial |
$22.75
|
| Rate for Payer: Healthscope Commercial |
$29.64
|
| Rate for Payer: Healthscope Commercial |
$24.46
|
| Rate for Payer: Healthscope Commercial |
$45.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.03
|
| Rate for Payer: PHP Commercial |
$23.10
|
| 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 SBD |
$20.75
|
| Rate for Payer: Priority Health SBD |
$17.12
|
| Rate for Payer: Priority Health SBD |
$31.95
|
| Rate for Payer: Priority Health SBD |
$15.93
|
|
|
FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
IP
|
$82.31
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
115589
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.86 |
| Max. Negotiated Rate |
$74.08 |
| Rate for Payer: Aetna Commercial |
$69.96
|
| Rate for Payer: Aetna Commercial |
$55.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.50
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$65.85
|
| Rate for Payer: Cofinity Advantage |
$57.62
|
| Rate for Payer: Cofinity Advantage |
$46.07
|
| Rate for Payer: Cofinity Commercial |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$70.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.85
|
| Rate for Payer: Healthscope Commercial |
$59.23
|
| Rate for Payer: Healthscope Commercial |
$74.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.36
|
| Rate for Payer: PHP Commercial |
$55.94
|
| Rate for Payer: PHP Commercial |
$69.96
|
| Rate for Payer: Priority Health SBD |
$41.46
|
| Rate for Payer: Priority Health SBD |
$51.86
|
|
|
FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
OP
|
$65.81
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
115589
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$59.23 |
| Rate for Payer: Aetna Commercial |
$55.94
|
| Rate for Payer: Aetna Commercial |
$69.96
|
| Rate for Payer: Aetna Medicare |
$41.16
|
| Rate for Payer: Aetna Medicare |
$32.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.50
|
| Rate for Payer: BCBS Complete |
$32.92
|
| Rate for Payer: BCBS Complete |
$26.32
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.19
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$65.85
|
| Rate for Payer: Cash Price |
$65.85
|
| Rate for Payer: Cofinity Advantage |
$46.07
|
| Rate for Payer: Cofinity Advantage |
$57.62
|
| Rate for Payer: Cofinity Commercial |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$70.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.65
|
| Rate for Payer: Healthscope Commercial |
$74.08
|
| Rate for Payer: Healthscope Commercial |
$59.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.73
|
| Rate for Payer: PHP Commercial |
$55.94
|
| Rate for Payer: PHP Commercial |
$69.96
|
| Rate for Payer: Priority Health SBD |
$41.46
|
| Rate for Payer: Priority Health SBD |
$51.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.78
|
| Rate for Payer: UHC Core |
$34.29
|
| Rate for Payer: UHC Core |
$42.88
|
| Rate for Payer: UHC Exchange |
$25.86
|
| Rate for Payer: UHC Exchange |
$32.35
|
|
|
FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
IP
|
$194.31
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
39803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.42 |
| Max. Negotiated Rate |
$174.88 |
| Rate for Payer: Aetna Commercial |
$165.16
|
| Rate for Payer: Aetna Commercial |
$112.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.30
|
| Rate for Payer: Cash Price |
$105.47
|
| Rate for Payer: Cash Price |
$155.45
|
| Rate for Payer: Cofinity Advantage |
$92.29
|
| Rate for Payer: Cofinity Advantage |
$136.02
|
| Rate for Payer: Cofinity Commercial |
$167.11
|
| Rate for Payer: Cofinity Commercial |
$113.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.47
|
| Rate for Payer: Healthscope Commercial |
$174.88
|
| Rate for Payer: Healthscope Commercial |
$118.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.73
|
| Rate for Payer: PHP Commercial |
$112.06
|
| Rate for Payer: PHP Commercial |
$165.16
|
| Rate for Payer: Priority Health SBD |
$122.42
|
| Rate for Payer: Priority Health SBD |
$83.06
|
|
|
FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
OP
|
$131.84
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
39803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$118.66 |
| Rate for Payer: Aetna Commercial |
$112.06
|
| Rate for Payer: Aetna Commercial |
$165.16
|
| Rate for Payer: Aetna Medicare |
$97.16
|
| Rate for Payer: Aetna Medicare |
$65.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.30
|
| Rate for Payer: BCBS Complete |
$77.72
|
| Rate for Payer: BCBS Complete |
$52.74
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.19
|
| Rate for Payer: Cash Price |
$105.47
|
| Rate for Payer: Cash Price |
$105.47
|
| Rate for Payer: Cash Price |
$155.45
|
| Rate for Payer: Cash Price |
$155.45
|
| Rate for Payer: Cofinity Advantage |
$92.29
|
| Rate for Payer: Cofinity Advantage |
$136.02
|
| Rate for Payer: Cofinity Commercial |
$113.38
|
| Rate for Payer: Cofinity Commercial |
$167.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.47
|
| Rate for Payer: Healthscope Commercial |
$174.88
|
| Rate for Payer: Healthscope Commercial |
$118.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.73
|
| Rate for Payer: PHP Commercial |
$112.06
|
| Rate for Payer: PHP Commercial |
$165.16
|
| Rate for Payer: Priority Health SBD |
$83.06
|
| Rate for Payer: Priority Health SBD |
$122.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.70
|
| Rate for Payer: UHC Core |
$68.69
|
| Rate for Payer: UHC Core |
$101.24
|
| Rate for Payer: UHC Exchange |
$51.81
|
| Rate for Payer: UHC Exchange |
$76.36
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$6,336.68
|
|
|
Service Code
|
APR-DRG 3141
|
| Min. Negotiated Rate |
$6,034.94 |
| Max. Negotiated Rate |
$6,336.68 |
| Rate for Payer: BCBS Complete |
$6,336.68
|
| Rate for Payer: Mclaren Medicaid |
$6,034.94
|
| Rate for Payer: Meridian Medicaid |
$6,336.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,034.94
|
| Rate for Payer: UHC Medicaid |
$6,034.94
|
| Rate for Payer: UHCCP Medicaid |
$6,034.94
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$16,772.46
|
|
|
Service Code
|
APR-DRG 3144
|
| Min. Negotiated Rate |
$15,973.78 |
| Max. Negotiated Rate |
$16,772.46 |
| Rate for Payer: BCBS Complete |
$16,772.46
|
| Rate for Payer: Mclaren Medicaid |
$15,973.78
|
| Rate for Payer: Meridian Medicaid |
$16,772.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,973.78
|
| Rate for Payer: UHC Medicaid |
$15,973.78
|
| Rate for Payer: UHCCP Medicaid |
$15,973.78
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$8,984.76
|
|
|
Service Code
|
APR-DRG 3142
|
| Min. Negotiated Rate |
$8,556.91 |
| Max. Negotiated Rate |
$8,984.76 |
| Rate for Payer: BCBS Complete |
$8,984.76
|
| Rate for Payer: Mclaren Medicaid |
$8,556.91
|
| Rate for Payer: Meridian Medicaid |
$8,984.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,556.91
|
| Rate for Payer: UHC Medicaid |
$8,556.91
|
| Rate for Payer: UHCCP Medicaid |
$8,556.91
|
|
