|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$12,449.21
|
|
|
Service Code
|
APR-DRG 3143
|
| Min. Negotiated Rate |
$11,856.39 |
| Max. Negotiated Rate |
$12,449.21 |
| Rate for Payer: BCBS Complete |
$12,449.21
|
| Rate for Payer: Mclaren Medicaid |
$11,856.39
|
| Rate for Payer: Meridian Medicaid |
$12,449.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,856.39
|
| Rate for Payer: UHC Medicaid |
$11,856.39
|
| Rate for Payer: UHCCP Medicaid |
$11,856.39
|
|
|
FOOT PROCEDURES WITH CC
|
Facility
|
IP
|
$32,612.03
|
|
|
Service Code
|
MSDRG 504
|
| Min. Negotiated Rate |
$14,273.38 |
| Max. Negotiated Rate |
$32,612.03 |
| Rate for Payer: Aetna Medicare |
$15,625.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,780.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,780.76
|
| Rate for Payer: BCBS MAPPO |
$15,024.61
|
| Rate for Payer: BCBS Trust/PPO |
$32,612.03
|
| Rate for Payer: BCN Commercial |
$32,612.03
|
| Rate for Payer: BCN Medicare Advantage |
$15,024.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,024.61
|
| Rate for Payer: Mclaren Medicare |
$15,024.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,775.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,278.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,527.07
|
| Rate for Payer: Nomi Health Commercial |
$24,112.68
|
| Rate for Payer: PACE Medicare |
$14,273.38
|
| Rate for Payer: PACE SWMI |
$15,024.61
|
| Rate for Payer: PHP Medicare Advantage |
$15,024.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30,135.50
|
| Rate for Payer: Priority Health Medicare |
$15,024.61
|
| Rate for Payer: Priority Health Tiered Network |
$24,108.40
|
| Rate for Payer: Railroad Medicare Medicare |
$15,024.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,467.96
|
| Rate for Payer: UHC Core |
$25,490.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,024.61
|
| Rate for Payer: UHC Exchange |
$20,817.28
|
| Rate for Payer: VA VA |
$15,024.61
|
|
|
FOOT PROCEDURES WITH MCC
|
Facility
|
IP
|
$46,514.04
|
|
|
Service Code
|
MSDRG 503
|
| Min. Negotiated Rate |
$21,041.81 |
| Max. Negotiated Rate |
$46,514.04 |
| Rate for Payer: Aetna Medicare |
$23,035.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,686.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,686.59
|
| Rate for Payer: BCBS MAPPO |
$22,149.27
|
| Rate for Payer: BCBS Trust/PPO |
$46,514.04
|
| Rate for Payer: BCN Commercial |
$46,514.04
|
| Rate for Payer: BCN Medicare Advantage |
$22,149.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,149.27
|
| Rate for Payer: Mclaren Medicare |
$22,149.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,256.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,471.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$24,364.20
|
| Rate for Payer: Nomi Health Commercial |
$36,005.19
|
| Rate for Payer: PACE Medicare |
$21,041.81
|
| Rate for Payer: PACE SWMI |
$22,149.27
|
| Rate for Payer: PHP Medicare Advantage |
$22,149.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$44,998.50
|
| Rate for Payer: Priority Health Medicare |
$22,149.27
|
| Rate for Payer: Priority Health Tiered Network |
$35,998.80
|
| Rate for Payer: Railroad Medicare Medicare |
$22,149.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45,494.93
|
| Rate for Payer: UHC Core |
$38,062.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22,149.27
|
| Rate for Payer: UHC Exchange |
$31,084.48
|
| Rate for Payer: VA VA |
$22,149.27
|
|
|
FOOT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$29,222.64
|
|
|
Service Code
|
MSDRG 505
|
| Min. Negotiated Rate |
$13,712.45 |
| Max. Negotiated Rate |
$29,222.64 |
| Rate for Payer: Aetna Medicare |
$15,011.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,042.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,042.70
|
| Rate for Payer: BCBS MAPPO |
$14,434.16
|
| Rate for Payer: BCBS Trust/PPO |
$26,057.79
|
| Rate for Payer: BCN Commercial |
$26,057.79
|
| Rate for Payer: BCN Medicare Advantage |
$14,434.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,434.16
|
| Rate for Payer: Mclaren Medicare |
$14,434.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,155.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,599.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,877.58
|
| Rate for Payer: Nomi Health Commercial |
$23,127.12
|
| Rate for Payer: PACE Medicare |
$13,712.45
|
| Rate for Payer: PACE SWMI |
$14,434.16
|
| Rate for Payer: PHP Medicare Advantage |
$14,434.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28,903.77
|
| Rate for Payer: Priority Health Medicare |
$14,434.16
|
| Rate for Payer: Priority Health Tiered Network |
$23,123.01
|
| Rate for Payer: Railroad Medicare Medicare |
$14,434.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,222.64
|
| Rate for Payer: UHC Core |
$24,448.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,434.16
|
| Rate for Payer: UHC Exchange |
$19,966.41
|
| Rate for Payer: VA VA |
$14,434.16
|
|
|
FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$17.83
|
|
|
Service Code
|
HCPCS J7606
|
| Hospital Charge Code |
88225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Medicare |
$8.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.59
|
| Rate for Payer: BCBS Complete |
$7.13
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cofinity Advantage |
$12.48
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.37
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2.20
|
| Rate for Payer: Priority Health SBD |
$11.23
|
| Rate for Payer: Priority Health Tiered Network |
$1.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.59
|
| Rate for Payer: UHC Core |
$9.29
|
| Rate for Payer: UHC Exchange |
$7.01
|
|
|
FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$17.83
|
|
|
Service Code
|
HCPCS J7606
|
| Hospital Charge Code |
88225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.59
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cofinity Advantage |
$12.48
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.37
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: Priority Health SBD |
$11.23
|
|
|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$293.15
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
106783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$263.83 |
| Rate for Payer: Aetna Commercial |
$249.18
|
| Rate for Payer: Aetna Commercial |
$364.53
|
| Rate for Payer: Aetna Commercial |
$442.43
|
| Rate for Payer: Aetna Commercial |
$235.76
|
| Rate for Payer: Aetna Commercial |
$320.10
|
| Rate for Payer: Aetna Commercial |
$182.86
|
| Rate for Payer: Aetna Commercial |
$1,256.31
|
| Rate for Payer: Aetna Medicare |
$107.56
|
| Rate for Payer: Aetna Medicare |
$214.43
|
| Rate for Payer: Aetna Medicare |
$188.29
|
| Rate for Payer: Aetna Medicare |
$146.57
|
| Rate for Payer: Aetna Medicare |
$260.25
|
| Rate for Payer: Aetna Medicare |
$138.69
|
| Rate for Payer: Aetna Medicare |
$739.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.78
|
| Rate for Payer: BCBS Complete |
$117.26
|
| Rate for Payer: BCBS Complete |
$110.95
|
| Rate for Payer: BCBS Complete |
$208.20
|
| Rate for Payer: BCBS Complete |
$150.64
|
| Rate for Payer: BCBS Complete |
$591.20
|
| Rate for Payer: BCBS Complete |
$86.05
|
| Rate for Payer: BCBS Complete |
$171.54
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$234.52
|
| Rate for Payer: Cash Price |
$172.10
|
| Rate for Payer: Cash Price |
$1,182.41
|
| Rate for Payer: Cash Price |
$1,182.41
|
| Rate for Payer: Cash Price |
$221.90
|
| Rate for Payer: Cash Price |
$172.10
|
| Rate for Payer: Cash Price |
$221.90
|
| Rate for Payer: Cash Price |
$234.52
|
| Rate for Payer: Cash Price |
$301.27
|
| Rate for Payer: Cash Price |
$301.27
|
| Rate for Payer: Cash Price |
$343.09
|
| Rate for Payer: Cash Price |
$343.09
|
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cofinity Advantage |
$150.59
|
| Rate for Payer: Cofinity Advantage |
$205.21
|
| Rate for Payer: Cofinity Advantage |
$194.16
|
| Rate for Payer: Cofinity Advantage |
$1,034.61
|
| Rate for Payer: Cofinity Advantage |
$300.20
|
| Rate for Payer: Cofinity Advantage |
$364.35
|
| Rate for Payer: Cofinity Advantage |
$263.61
|
| Rate for Payer: Cofinity Commercial |
$323.87
|
| Rate for Payer: Cofinity Commercial |
$252.11
|
| Rate for Payer: Cofinity Commercial |
$447.63
|
| Rate for Payer: Cofinity Commercial |
$185.01
|
| Rate for Payer: Cofinity Commercial |
$1,271.09
|
| Rate for Payer: Cofinity Commercial |
$238.54
|
| Rate for Payer: Cofinity Commercial |
$368.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.27
|
| Rate for Payer: Healthscope Commercial |
$385.97
|
| Rate for Payer: Healthscope Commercial |
$1,330.21
|
| Rate for Payer: Healthscope Commercial |
$468.45
|
| Rate for Payer: Healthscope Commercial |
$193.62
|
| Rate for Payer: Healthscope Commercial |
$338.93
|
| Rate for Payer: Healthscope Commercial |
$249.63
|
| Rate for Payer: Healthscope Commercial |
$263.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$343.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,182.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$301.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,256.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,108.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.64
|
| Rate for Payer: PHP Commercial |
$1,256.31
|
| Rate for Payer: PHP Commercial |
$235.76
|
| Rate for Payer: PHP Commercial |
$249.18
|
| Rate for Payer: PHP Commercial |
$320.10
|
| Rate for Payer: PHP Commercial |
$364.53
|
| Rate for Payer: PHP Commercial |
$442.43
|
| Rate for Payer: PHP Commercial |
$182.86
|
| Rate for Payer: Priority Health SBD |
$270.18
|
| Rate for Payer: Priority Health SBD |
$931.15
|
| Rate for Payer: Priority Health SBD |
$327.92
|
| Rate for Payer: Priority Health SBD |
$237.25
|
| Rate for Payer: Priority Health SBD |
$184.68
|
| Rate for Payer: Priority Health SBD |
$135.53
|
| Rate for Payer: Priority Health SBD |
$174.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
|
|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$520.50
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
106783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$327.92 |
| Max. Negotiated Rate |
$468.45 |
| Rate for Payer: Aetna Commercial |
$442.43
|
| Rate for Payer: Aetna Commercial |
$235.76
|
| Rate for Payer: Aetna Commercial |
$1,256.31
|
| Rate for Payer: Aetna Commercial |
$249.18
|
| Rate for Payer: Aetna Commercial |
$364.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.32
|
| Rate for Payer: Cash Price |
$234.52
|
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cash Price |
$221.90
|
| Rate for Payer: Cash Price |
$1,182.41
|
| Rate for Payer: Cash Price |
$343.09
|
| Rate for Payer: Cofinity Advantage |
$300.20
|
| Rate for Payer: Cofinity Advantage |
$205.21
|
| Rate for Payer: Cofinity Advantage |
$364.35
|
| Rate for Payer: Cofinity Advantage |
$1,034.61
|
| Rate for Payer: Cofinity Advantage |
$194.16
|
| Rate for Payer: Cofinity Commercial |
$447.63
|
| Rate for Payer: Cofinity Commercial |
$252.11
|
| Rate for Payer: Cofinity Commercial |
$368.82
|
| Rate for Payer: Cofinity Commercial |
$238.54
|
| Rate for Payer: Cofinity Commercial |
$1,271.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.40
|
| Rate for Payer: Healthscope Commercial |
$263.83
|
| Rate for Payer: Healthscope Commercial |
$468.45
|
| Rate for Payer: Healthscope Commercial |
$249.63
|
| Rate for Payer: Healthscope Commercial |
$1,330.21
|
| Rate for Payer: Healthscope Commercial |
$385.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,256.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,108.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.38
|
| Rate for Payer: PHP Commercial |
$1,256.31
|
| Rate for Payer: PHP Commercial |
$364.53
|
| Rate for Payer: PHP Commercial |
$442.43
|
| Rate for Payer: PHP Commercial |
$235.76
|
| Rate for Payer: PHP Commercial |
$249.18
|
| Rate for Payer: Priority Health SBD |
$270.18
|
| Rate for Payer: Priority Health SBD |
$184.68
|
| Rate for Payer: Priority Health SBD |
$174.74
|
| Rate for Payer: Priority Health SBD |
$931.15
|
| Rate for Payer: Priority Health SBD |
$327.92
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$194.25
|
|
|
Service Code
|
NDC 70700026899
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.34 |
| Max. Negotiated Rate |
$174.82 |
| Rate for Payer: Aetna Commercial |
$165.11
|
| Rate for Payer: Aetna Medicare |
$97.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.26
|
| Rate for Payer: BCBS Complete |
$77.70
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Advantage |
$135.97
|
| Rate for Payer: Cofinity Commercial |
$167.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Healthscope Commercial |
$174.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.69
|
| Rate for Payer: PHP Commercial |
$165.11
|
| Rate for Payer: Priority Health SBD |
$122.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.26
|
| Rate for Payer: UHC Core |
$101.20
|
| Rate for Payer: UHC Exchange |
$76.34
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$194.25
|
|
|
Service Code
|
NDC 70700026899
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$174.82 |
| Rate for Payer: Aetna Commercial |
$165.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.26
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Advantage |
$135.97
|
| Rate for Payer: Cofinity Commercial |
$167.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Healthscope Commercial |
$174.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.69
|
| Rate for Payer: PHP Commercial |
$165.11
|
| Rate for Payer: Priority Health SBD |
$122.38
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$194.25
|
|
|
Service Code
|
NDC 70700026894
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.34 |
| Max. Negotiated Rate |
$174.82 |
| Rate for Payer: Aetna Commercial |
$165.11
|
| Rate for Payer: Aetna Medicare |
$97.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.26
|
| Rate for Payer: BCBS Complete |
$77.70
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Advantage |
$135.97
|
| Rate for Payer: Cofinity Commercial |
$167.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Healthscope Commercial |
$174.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.69
|
| Rate for Payer: PHP Commercial |
$165.11
|
| Rate for Payer: Priority Health SBD |
$122.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.26
|
| Rate for Payer: UHC Core |
$101.20
|
| Rate for Payer: UHC Exchange |
$76.34
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$194.25
|
|
|
Service Code
|
NDC 70700026894
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$174.82 |
| Rate for Payer: Aetna Commercial |
$165.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.26
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Advantage |
$135.97
|
| Rate for Payer: Cofinity Commercial |
$167.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Healthscope Commercial |
$174.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.69
|
| Rate for Payer: PHP Commercial |
$165.11
|
| Rate for Payer: Priority Health SBD |
$122.38
|
|
|
FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION
|
Facility
|
OP
|
$167.32
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
17764
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$150.59 |
| Rate for Payer: Aetna Commercial |
$142.22
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$133.86
|
| Rate for Payer: Cash Price |
$133.86
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cofinity Advantage |
$117.12
|
| Rate for Payer: Cofinity Advantage |
$10.61
|
| Rate for Payer: Cofinity Advantage |
$15.86
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Cofinity Commercial |
$143.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Healthscope Commercial |
$20.39
|
| Rate for Payer: Healthscope Commercial |
$150.59
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Mclaren Medicaid |
$0.70
|
| Rate for Payer: Mclaren Medicaid |
$0.70
|
| Rate for Payer: Mclaren Medicaid |
$0.70
|
| Rate for Payer: Mclaren Medicare |
$1.33
|
| Rate for Payer: Mclaren Medicare |
$1.33
|
| Rate for Payer: Mclaren Medicare |
$1.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.40
|
| Rate for Payer: Meridian Medicaid |
$1.40
|
| Rate for Payer: Meridian Medicaid |
$1.40
|
| Rate for Payer: Meridian Medicaid |
$1.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.25
|
| Rate for Payer: Nomi Health Commercial |
$3.99
|
| Rate for Payer: Nomi Health Commercial |
$3.99
|
| Rate for Payer: Nomi Health Commercial |
$3.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.49
|
| Rate for Payer: PACE Medicare |
$1.26
|
| Rate for Payer: PACE Medicare |
$1.26
|
| Rate for Payer: PACE Medicare |
$1.26
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$19.25
|
| Rate for Payer: PHP Commercial |
$142.22
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.64
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: Priority Health SBD |
$105.41
|
| Rate for Payer: Priority Health SBD |
$14.27
|
| Rate for Payer: Priority Health Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.33
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: VA VA |
$1.33
|
| Rate for Payer: VA VA |
$1.33
|
| Rate for Payer: VA VA |
$1.33
|
|
|
FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$167.32
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
17764
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.41 |
| Max. Negotiated Rate |
$150.59 |
| Rate for Payer: Aetna Commercial |
$142.22
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.85
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$133.86
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cofinity Advantage |
$117.12
|
| Rate for Payer: Cofinity Advantage |
$10.61
|
| Rate for Payer: Cofinity Advantage |
$15.86
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$143.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.12
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$150.59
|
| Rate for Payer: Healthscope Commercial |
$20.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.49
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$19.25
|
| Rate for Payer: PHP Commercial |
$142.22
|
| Rate for Payer: Priority Health SBD |
$14.27
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: Priority Health SBD |
$105.41
|
|
|
FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION
|
Facility
|
OP
|
$106.18
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
88010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$95.56 |
| Rate for Payer: Aetna Commercial |
$90.25
|
| Rate for Payer: Aetna Commercial |
$52.58
|
| Rate for Payer: Aetna Commercial |
$340.37
|
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$49.49
|
| Rate for Payer: Cash Price |
$320.35
|
| Rate for Payer: Cash Price |
$320.35
|
| Rate for Payer: Cash Price |
$84.94
|
| Rate for Payer: Cash Price |
$84.94
|
| Rate for Payer: Cash Price |
$49.49
|
| Rate for Payer: Cofinity Advantage |
$34.77
|
| Rate for Payer: Cofinity Advantage |
$74.33
|
| Rate for Payer: Cofinity Advantage |
$280.31
|
| Rate for Payer: Cofinity Advantage |
$43.30
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$344.38
|
| Rate for Payer: Cofinity Commercial |
$53.20
|
| Rate for Payer: Cofinity Commercial |
$91.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Healthscope Commercial |
$360.40
|
| Rate for Payer: Healthscope Commercial |
$55.67
|
| Rate for Payer: Healthscope Commercial |
$95.56
|
| Rate for Payer: Healthscope Commercial |
$44.70
|
| Rate for Payer: Mclaren Medicaid |
$0.70
|
| Rate for Payer: Mclaren Medicaid |
$0.70
|
| Rate for Payer: Mclaren Medicaid |
$0.70
|
| Rate for Payer: Mclaren Medicaid |
$0.70
|
| Rate for Payer: Mclaren Medicare |
$1.33
|
| Rate for Payer: Mclaren Medicare |
$1.33
|
| Rate for Payer: Mclaren Medicare |
$1.33
|
| Rate for Payer: Mclaren Medicare |
$1.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.40
|
| Rate for Payer: Meridian Medicaid |
$1.40
|
| Rate for Payer: Meridian Medicaid |
$1.40
|
| Rate for Payer: Meridian Medicaid |
$1.40
|
| Rate for Payer: Meridian Medicaid |
$1.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.25
|
| Rate for Payer: Nomi Health Commercial |
$3.99
|
| Rate for Payer: Nomi Health Commercial |
$3.99
|
| Rate for Payer: Nomi Health Commercial |
$3.99
|
| Rate for Payer: Nomi Health Commercial |
$3.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.33
|
| Rate for Payer: PACE Medicare |
$1.26
|
| Rate for Payer: PACE Medicare |
$1.26
|
| Rate for Payer: PACE Medicare |
$1.26
|
| Rate for Payer: PACE Medicare |
$1.26
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PHP Commercial |
$52.58
|
| Rate for Payer: PHP Commercial |
$90.25
|
| Rate for Payer: PHP Commercial |
$340.37
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.64
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health SBD |
$38.97
|
| Rate for Payer: Priority Health SBD |
$66.89
|
| Rate for Payer: Priority Health SBD |
$31.29
|
| Rate for Payer: Priority Health SBD |
$252.28
|
| Rate for Payer: Priority Health Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.33
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: VA VA |
$1.33
|
| Rate for Payer: VA VA |
$1.33
|
| Rate for Payer: VA VA |
$1.33
|
| Rate for Payer: VA VA |
$1.33
|
|
|
FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION
|
Facility
|
IP
|
$61.86
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
88010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.97 |
| Max. Negotiated Rate |
$55.67 |
| Rate for Payer: Aetna Commercial |
$52.58
|
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna Commercial |
$90.25
|
| Rate for Payer: Aetna Commercial |
$340.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.21
|
| Rate for Payer: Cash Price |
$84.94
|
| Rate for Payer: Cash Price |
$320.35
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$49.49
|
| Rate for Payer: Cofinity Advantage |
$280.31
|
| Rate for Payer: Cofinity Advantage |
$34.77
|
| Rate for Payer: Cofinity Advantage |
$43.30
|
| Rate for Payer: Cofinity Advantage |
$74.33
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$344.38
|
| Rate for Payer: Cofinity Commercial |
$53.20
|
| Rate for Payer: Cofinity Commercial |
$91.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.49
|
| Rate for Payer: Healthscope Commercial |
$95.56
|
| Rate for Payer: Healthscope Commercial |
$44.70
|
| Rate for Payer: Healthscope Commercial |
$360.40
|
| Rate for Payer: Healthscope Commercial |
$55.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.40
|
| Rate for Payer: PHP Commercial |
$340.37
|
| Rate for Payer: PHP Commercial |
$90.25
|
| Rate for Payer: PHP Commercial |
$52.58
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: Priority Health SBD |
$31.29
|
| Rate for Payer: Priority Health SBD |
$252.28
|
| Rate for Payer: Priority Health SBD |
$38.97
|
| Rate for Payer: Priority Health SBD |
$66.89
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$12,226.20
|
|
|
Service Code
|
APR-DRG 3404
|
| Min. Negotiated Rate |
$11,644.00 |
| Max. Negotiated Rate |
$12,226.20 |
| Rate for Payer: BCBS Complete |
$12,226.20
|
| Rate for Payer: Mclaren Medicaid |
$11,644.00
|
| Rate for Payer: Meridian Medicaid |
$12,226.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,644.00
|
| Rate for Payer: UHC Medicaid |
$11,644.00
|
| Rate for Payer: UHCCP Medicaid |
$11,644.00
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$8,200.48
|
|
|
Service Code
|
APR-DRG 3403
|
| Min. Negotiated Rate |
$7,809.98 |
| Max. Negotiated Rate |
$8,200.48 |
| Rate for Payer: BCBS Complete |
$8,200.48
|
| Rate for Payer: Mclaren Medicaid |
$7,809.98
|
| Rate for Payer: Meridian Medicaid |
$8,200.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,809.98
|
| Rate for Payer: UHC Medicaid |
$7,809.98
|
| Rate for Payer: UHCCP Medicaid |
$7,809.98
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$4,467.15
|
|
|
Service Code
|
APR-DRG 3402
|
| Min. Negotiated Rate |
$4,254.43 |
| Max. Negotiated Rate |
$4,467.15 |
| Rate for Payer: BCBS Complete |
$4,467.15
|
| Rate for Payer: Mclaren Medicaid |
$4,254.43
|
| Rate for Payer: Meridian Medicaid |
$4,467.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,254.43
|
| Rate for Payer: UHC Medicaid |
$4,254.43
|
| Rate for Payer: UHCCP Medicaid |
$4,254.43
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$3,458.72
|
|
|
Service Code
|
APR-DRG 3401
|
| Min. Negotiated Rate |
$3,294.02 |
| Max. Negotiated Rate |
$3,458.72 |
| Rate for Payer: BCBS Complete |
$3,458.72
|
| Rate for Payer: Mclaren Medicaid |
$3,294.02
|
| Rate for Payer: Meridian Medicaid |
$3,458.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,294.02
|
| Rate for Payer: UHC Medicaid |
$3,294.02
|
| Rate for Payer: UHCCP Medicaid |
$3,294.02
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$17,024.72
|
|
|
Service Code
|
APR-DRG 3414
|
| Min. Negotiated Rate |
$16,214.02 |
| Max. Negotiated Rate |
$17,024.72 |
| Rate for Payer: BCBS Complete |
$17,024.72
|
| Rate for Payer: Mclaren Medicaid |
$16,214.02
|
| Rate for Payer: Meridian Medicaid |
$17,024.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,214.02
|
| Rate for Payer: UHC Medicaid |
$16,214.02
|
| Rate for Payer: UHCCP Medicaid |
$16,214.02
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$3,248.89
|
|
|
Service Code
|
APR-DRG 3411
|
| Min. Negotiated Rate |
$3,094.18 |
| Max. Negotiated Rate |
$3,248.89 |
| Rate for Payer: BCBS Complete |
$3,248.89
|
| Rate for Payer: Mclaren Medicaid |
$3,094.18
|
| Rate for Payer: Meridian Medicaid |
$3,248.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,094.18
|
| Rate for Payer: UHC Medicaid |
$3,094.18
|
| Rate for Payer: UHCCP Medicaid |
$3,094.18
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$4,608.76
|
|
|
Service Code
|
APR-DRG 3412
|
| Min. Negotiated Rate |
$4,389.29 |
| Max. Negotiated Rate |
$4,608.76 |
| Rate for Payer: BCBS Complete |
$4,608.76
|
| Rate for Payer: Mclaren Medicaid |
$4,389.29
|
| Rate for Payer: Meridian Medicaid |
$4,608.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,389.29
|
| Rate for Payer: UHC Medicaid |
$4,389.29
|
| Rate for Payer: UHCCP Medicaid |
$4,389.29
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$9,882.55
|
|
|
Service Code
|
APR-DRG 3413
|
| Min. Negotiated Rate |
$9,411.95 |
| Max. Negotiated Rate |
$9,882.55 |
| Rate for Payer: BCBS Complete |
$9,882.55
|
| Rate for Payer: Mclaren Medicaid |
$9,411.95
|
| Rate for Payer: Meridian Medicaid |
$9,882.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,411.95
|
| Rate for Payer: UHC Medicaid |
$9,411.95
|
| Rate for Payer: UHCCP Medicaid |
$9,411.95
|
|
|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$5,578.21
|
|
|
Service Code
|
APR-DRG 3422
|
| Min. Negotiated Rate |
$5,312.58 |
| Max. Negotiated Rate |
$5,578.21 |
| Rate for Payer: BCBS Complete |
$5,578.21
|
| Rate for Payer: Mclaren Medicaid |
$5,312.58
|
| Rate for Payer: Meridian Medicaid |
$5,578.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,312.58
|
| Rate for Payer: UHC Medicaid |
$5,312.58
|
| Rate for Payer: UHCCP Medicaid |
$5,312.58
|
|
