|
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC
|
Facility
|
IP
|
$9,564.51
|
|
|
Service Code
|
MSDRG 390
|
| Min. Negotiated Rate |
$4,544.01 |
| Max. Negotiated Rate |
$9,564.51 |
| Rate for Payer: Aetna Medicare |
$4,974.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,978.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,978.96
|
| Rate for Payer: BCBS MAPPO |
$4,783.17
|
| Rate for Payer: BCBS Trust/PPO |
$9,564.51
|
| Rate for Payer: BCN Commercial |
$9,564.51
|
| Rate for Payer: BCN Medicare Advantage |
$4,783.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,783.17
|
| Rate for Payer: Mclaren Medicare |
$4,783.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,022.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,500.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,261.49
|
| Rate for Payer: Nomi Health Commercial |
$7,017.60
|
| Rate for Payer: PACE Medicare |
$4,544.01
|
| Rate for Payer: PACE SWMI |
$4,783.17
|
| Rate for Payer: PHP Medicare Advantage |
$4,783.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,770.44
|
| Rate for Payer: Priority Health Medicare |
$4,783.17
|
| Rate for Payer: Priority Health Tiered Network |
$7,016.35
|
| Rate for Payer: Railroad Medicare Medicare |
$4,783.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,867.20
|
| Rate for Payer: UHC Core |
$7,418.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,783.17
|
| Rate for Payer: UHC Exchange |
$6,058.53
|
| Rate for Payer: VA VA |
$4,783.17
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$15,822.51
|
|
|
Service Code
|
APR-DRG 2464
|
| Min. Negotiated Rate |
$15,069.05 |
| Max. Negotiated Rate |
$15,822.51 |
| Rate for Payer: BCBS Complete |
$15,822.51
|
| Rate for Payer: Mclaren Medicaid |
$15,069.05
|
| Rate for Payer: Meridian Medicaid |
$15,822.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,069.05
|
| Rate for Payer: UHC Medicaid |
$15,069.05
|
| Rate for Payer: UHCCP Medicaid |
$15,069.05
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$4,242.99
|
|
|
Service Code
|
APR-DRG 2461
|
| Min. Negotiated Rate |
$4,040.95 |
| Max. Negotiated Rate |
$4,242.99 |
| Rate for Payer: BCBS Complete |
$4,242.99
|
| Rate for Payer: Mclaren Medicaid |
$4,040.95
|
| Rate for Payer: Meridian Medicaid |
$4,242.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,040.95
|
| Rate for Payer: UHC Medicaid |
$4,040.95
|
| Rate for Payer: UHCCP Medicaid |
$4,040.95
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$5,722.11
|
|
|
Service Code
|
APR-DRG 2462
|
| Min. Negotiated Rate |
$5,449.63 |
| Max. Negotiated Rate |
$5,722.11 |
| Rate for Payer: BCBS Complete |
$5,722.11
|
| Rate for Payer: Mclaren Medicaid |
$5,449.63
|
| Rate for Payer: Meridian Medicaid |
$5,722.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,449.63
|
| Rate for Payer: UHC Medicaid |
$5,449.63
|
| Rate for Payer: UHCCP Medicaid |
$5,449.63
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$8,355.27
|
|
|
Service Code
|
APR-DRG 2463
|
| Min. Negotiated Rate |
$7,957.40 |
| Max. Negotiated Rate |
$8,355.27 |
| Rate for Payer: BCBS Complete |
$8,355.27
|
| Rate for Payer: Mclaren Medicaid |
$7,957.40
|
| Rate for Payer: Meridian Medicaid |
$8,355.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,957.40
|
| Rate for Payer: UHC Medicaid |
$7,957.40
|
| Rate for Payer: UHCCP Medicaid |
$7,957.40
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE
|
Facility
|
IP
|
$971.54
|
|
|
Service Code
|
NDC 00009034201
|
| Hospital Charge Code |
28025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$612.07 |
| Max. Negotiated Rate |
$874.39 |
| Rate for Payer: Aetna Commercial |
$825.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.50
|
| Rate for Payer: Cash Price |
$777.23
|
| Rate for Payer: Cofinity Advantage |
$680.08
|
| Rate for Payer: Cofinity Commercial |
$835.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.23
|
| Rate for Payer: Healthscope Commercial |
$874.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$728.65
|
| Rate for Payer: PHP Commercial |
$825.81
|
| Rate for Payer: Priority Health SBD |
$612.07
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE
|
Facility
|
OP
|
$707.59
|
|
|
Service Code
|
NDC 63713001974
|
| Hospital Charge Code |
28025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$278.08 |
| Max. Negotiated Rate |
$636.83 |
| Rate for Payer: Aetna Commercial |
$601.45
|
| Rate for Payer: Aetna Medicare |
$353.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$459.93
|
| Rate for Payer: BCBS Complete |
$283.04
|
| Rate for Payer: Cash Price |
$566.07
|
| Rate for Payer: Cofinity Advantage |
$495.31
|
| Rate for Payer: Cofinity Commercial |
$608.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.07
|
| Rate for Payer: Healthscope Commercial |
$636.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$566.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$530.69
|
| Rate for Payer: PHP Commercial |
$601.45
|
| Rate for Payer: Priority Health SBD |
$445.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$459.93
|
| Rate for Payer: UHC Core |
$368.65
|
| Rate for Payer: UHC Exchange |
$278.08
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE
|
Facility
|
OP
|
$971.54
|
|
|
Service Code
|
NDC 00009034201
|
| Hospital Charge Code |
28025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$381.82 |
| Max. Negotiated Rate |
$874.39 |
| Rate for Payer: Aetna Commercial |
$825.81
|
| Rate for Payer: Aetna Medicare |
$485.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.50
|
| Rate for Payer: BCBS Complete |
$388.62
|
| Rate for Payer: Cash Price |
$777.23
|
| Rate for Payer: Cofinity Advantage |
$680.08
|
| Rate for Payer: Cofinity Commercial |
$835.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.23
|
| Rate for Payer: Healthscope Commercial |
$874.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$777.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$728.65
|
| Rate for Payer: PHP Commercial |
$825.81
|
| Rate for Payer: Priority Health SBD |
$612.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$631.50
|
| Rate for Payer: UHC Core |
$506.17
|
| Rate for Payer: UHC Exchange |
$381.82
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE
|
Facility
|
IP
|
$707.59
|
|
|
Service Code
|
NDC 63713001974
|
| Hospital Charge Code |
28025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$445.78 |
| Max. Negotiated Rate |
$636.83 |
| Rate for Payer: Aetna Commercial |
$601.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$459.93
|
| Rate for Payer: Cash Price |
$566.07
|
| Rate for Payer: Cofinity Advantage |
$495.31
|
| Rate for Payer: Cofinity Commercial |
$608.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.07
|
| Rate for Payer: Healthscope Commercial |
$636.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$530.69
|
| Rate for Payer: PHP Commercial |
$601.45
|
| Rate for Payer: Priority Health SBD |
$445.78
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE
|
Facility
|
OP
|
$407.42
|
|
|
Service Code
|
NDC 00009031508
|
| Hospital Charge Code |
28018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$160.12 |
| Max. Negotiated Rate |
$366.68 |
| Rate for Payer: Aetna Commercial |
$346.31
|
| Rate for Payer: Aetna Medicare |
$203.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.82
|
| Rate for Payer: BCBS Complete |
$162.97
|
| Rate for Payer: Cash Price |
$325.94
|
| Rate for Payer: Cofinity Advantage |
$285.19
|
| Rate for Payer: Cofinity Commercial |
$350.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.94
|
| Rate for Payer: Healthscope Commercial |
$366.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$325.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$305.56
|
| Rate for Payer: PHP Commercial |
$346.31
|
| Rate for Payer: Priority Health SBD |
$256.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.82
|
| Rate for Payer: UHC Core |
$212.27
|
| Rate for Payer: UHC Exchange |
$160.12
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE
|
Facility
|
OP
|
$289.89
|
|
|
Service Code
|
NDC 63713001972
|
| Hospital Charge Code |
28018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.93 |
| Max. Negotiated Rate |
$260.90 |
| Rate for Payer: Aetna Commercial |
$246.41
|
| Rate for Payer: Aetna Medicare |
$144.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.43
|
| Rate for Payer: BCBS Complete |
$115.96
|
| Rate for Payer: Cash Price |
$231.91
|
| Rate for Payer: Cofinity Advantage |
$202.92
|
| Rate for Payer: Cofinity Commercial |
$249.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.91
|
| Rate for Payer: Healthscope Commercial |
$260.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.42
|
| Rate for Payer: PHP Commercial |
$246.41
|
| Rate for Payer: Priority Health SBD |
$182.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.43
|
| Rate for Payer: UHC Core |
$151.03
|
| Rate for Payer: UHC Exchange |
$113.93
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE
|
Facility
|
IP
|
$407.42
|
|
|
Service Code
|
NDC 00009031508
|
| Hospital Charge Code |
28018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$256.67 |
| Max. Negotiated Rate |
$366.68 |
| Rate for Payer: Aetna Commercial |
$346.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.82
|
| Rate for Payer: Cash Price |
$325.94
|
| Rate for Payer: Cofinity Advantage |
$285.19
|
| Rate for Payer: Cofinity Commercial |
$350.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.94
|
| Rate for Payer: Healthscope Commercial |
$366.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$305.56
|
| Rate for Payer: PHP Commercial |
$346.31
|
| Rate for Payer: Priority Health SBD |
$256.67
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE
|
Facility
|
IP
|
$289.89
|
|
|
Service Code
|
NDC 63713001972
|
| Hospital Charge Code |
28018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$182.63 |
| Max. Negotiated Rate |
$260.90 |
| Rate for Payer: Aetna Commercial |
$246.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.43
|
| Rate for Payer: Cash Price |
$231.91
|
| Rate for Payer: Cofinity Advantage |
$202.92
|
| Rate for Payer: Cofinity Commercial |
$249.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.91
|
| Rate for Payer: Healthscope Commercial |
$260.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.42
|
| Rate for Payer: PHP Commercial |
$246.41
|
| Rate for Payer: Priority Health SBD |
$182.63
|
|
|
GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$236.15
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
155791
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$148.77 |
| Max. Negotiated Rate |
$212.53 |
| Rate for Payer: Aetna Commercial |
$200.73
|
| Rate for Payer: Aetna Commercial |
$247.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.90
|
| Rate for Payer: Cash Price |
$188.92
|
| Rate for Payer: Cash Price |
$232.49
|
| Rate for Payer: Cofinity Advantage |
$165.31
|
| Rate for Payer: Cofinity Advantage |
$203.43
|
| Rate for Payer: Cofinity Commercial |
$203.09
|
| Rate for Payer: Cofinity Commercial |
$249.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.92
|
| Rate for Payer: Healthscope Commercial |
$261.55
|
| Rate for Payer: Healthscope Commercial |
$212.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.96
|
| Rate for Payer: PHP Commercial |
$200.73
|
| Rate for Payer: PHP Commercial |
$247.02
|
| Rate for Payer: Priority Health SBD |
$148.77
|
| Rate for Payer: Priority Health SBD |
$183.08
|
|
|
GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$290.61
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
155791
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$261.55 |
| Rate for Payer: Aetna Commercial |
$247.02
|
| Rate for Payer: Aetna Commercial |
$200.73
|
| Rate for Payer: Aetna Medicare |
$145.31
|
| Rate for Payer: Aetna Medicare |
$118.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.90
|
| Rate for Payer: BCBS Complete |
$116.24
|
| Rate for Payer: BCBS Complete |
$94.46
|
| Rate for Payer: BCBS Trust/PPO |
$8.84
|
| Rate for Payer: BCBS Trust/PPO |
$8.84
|
| Rate for Payer: BCN Commercial |
$8.84
|
| Rate for Payer: BCN Commercial |
$8.84
|
| Rate for Payer: Cash Price |
$188.92
|
| Rate for Payer: Cash Price |
$188.92
|
| Rate for Payer: Cash Price |
$232.49
|
| Rate for Payer: Cash Price |
$232.49
|
| Rate for Payer: Cofinity Advantage |
$165.31
|
| Rate for Payer: Cofinity Advantage |
$203.43
|
| Rate for Payer: Cofinity Commercial |
$249.92
|
| Rate for Payer: Cofinity Commercial |
$203.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.92
|
| Rate for Payer: Healthscope Commercial |
$212.53
|
| Rate for Payer: Healthscope Commercial |
$261.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.96
|
| Rate for Payer: PHP Commercial |
$247.02
|
| Rate for Payer: PHP Commercial |
$200.73
|
| Rate for Payer: Priority Health SBD |
$148.77
|
| Rate for Payer: Priority Health SBD |
$183.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
|
|
GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$472.45
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
155792
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$297.64 |
| Max. Negotiated Rate |
$425.20 |
| Rate for Payer: Aetna Commercial |
$401.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.09
|
| Rate for Payer: Cash Price |
$377.96
|
| Rate for Payer: Cofinity Advantage |
$330.71
|
| Rate for Payer: Cofinity Commercial |
$406.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.96
|
| Rate for Payer: Healthscope Commercial |
$425.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.34
|
| Rate for Payer: PHP Commercial |
$401.58
|
| Rate for Payer: Priority Health SBD |
$297.64
|
|
|
GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$472.45
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
155792
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$425.20 |
| Rate for Payer: Aetna Commercial |
$401.58
|
| Rate for Payer: Aetna Medicare |
$236.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.09
|
| Rate for Payer: BCBS Complete |
$188.98
|
| Rate for Payer: BCBS Trust/PPO |
$8.84
|
| Rate for Payer: BCN Commercial |
$8.84
|
| Rate for Payer: Cash Price |
$377.96
|
| Rate for Payer: Cash Price |
$377.96
|
| Rate for Payer: Cofinity Advantage |
$330.71
|
| Rate for Payer: Cofinity Commercial |
$406.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.96
|
| Rate for Payer: Healthscope Commercial |
$425.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$377.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.34
|
| Rate for Payer: PHP Commercial |
$401.58
|
| Rate for Payer: Priority Health SBD |
$297.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
OP
|
$2.35
|
|
|
Service Code
|
NDC 60687022411
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: Aetna Medicare |
$1.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.53
|
| Rate for Payer: BCBS Complete |
$0.94
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Advantage |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.76
|
| Rate for Payer: PHP Commercial |
$2.00
|
| Rate for Payer: Priority Health SBD |
$1.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.53
|
| Rate for Payer: UHC Core |
$1.22
|
| Rate for Payer: UHC Exchange |
$0.92
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
OP
|
$234.65
|
|
|
Service Code
|
NDC 60687022401
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.22 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna Medicare |
$117.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.52
|
| Rate for Payer: BCBS Complete |
$93.86
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Advantage |
$164.25
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health SBD |
$147.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.52
|
| Rate for Payer: UHC Core |
$122.25
|
| Rate for Payer: UHC Exchange |
$92.22
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
IP
|
$2.35
|
|
|
Service Code
|
NDC 60687022411
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.53
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Advantage |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.76
|
| Rate for Payer: PHP Commercial |
$2.00
|
| Rate for Payer: Priority Health SBD |
$1.48
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
IP
|
$163.56
|
|
|
Service Code
|
NDC 69097082103
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.04 |
| Max. Negotiated Rate |
$147.20 |
| Rate for Payer: Aetna Commercial |
$139.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.31
|
| Rate for Payer: Cash Price |
$130.85
|
| Rate for Payer: Cofinity Advantage |
$114.49
|
| Rate for Payer: Cofinity Commercial |
$140.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.85
|
| Rate for Payer: Healthscope Commercial |
$147.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.67
|
| Rate for Payer: PHP Commercial |
$139.03
|
| Rate for Payer: Priority Health SBD |
$103.04
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
IP
|
$234.65
|
|
|
Service Code
|
NDC 60687022401
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.83 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.52
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Advantage |
$164.25
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health SBD |
$147.83
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
OP
|
$163.56
|
|
|
Service Code
|
NDC 69097082103
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.28 |
| Max. Negotiated Rate |
$147.20 |
| Rate for Payer: Aetna Commercial |
$139.03
|
| Rate for Payer: Aetna Medicare |
$81.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.31
|
| Rate for Payer: BCBS Complete |
$65.42
|
| Rate for Payer: Cash Price |
$130.85
|
| Rate for Payer: Cofinity Advantage |
$114.49
|
| Rate for Payer: Cofinity Commercial |
$140.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.85
|
| Rate for Payer: Healthscope Commercial |
$147.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.67
|
| Rate for Payer: PHP Commercial |
$139.03
|
| Rate for Payer: Priority Health SBD |
$103.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.31
|
| Rate for Payer: UHC Core |
$85.21
|
| Rate for Payer: UHC Exchange |
$64.28
|
|
|
GENDER RELATED PROCEDURES
|
Facility
|
IP
|
$10,090.65
|
|
|
Service Code
|
APR-DRG 8511
|
| Min. Negotiated Rate |
$9,610.15 |
| Max. Negotiated Rate |
$10,090.65 |
| Rate for Payer: BCBS Complete |
$10,090.65
|
| Rate for Payer: Mclaren Medicaid |
$9,610.15
|
| Rate for Payer: Meridian Medicaid |
$10,090.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,610.15
|
| Rate for Payer: UHC Medicaid |
$9,610.15
|
| Rate for Payer: UHCCP Medicaid |
$9,610.15
|
|
|
GENDER RELATED PROCEDURES
|
Facility
|
IP
|
$55,723.04
|
|
|
Service Code
|
APR-DRG 8513
|
| Min. Negotiated Rate |
$53,069.56 |
| Max. Negotiated Rate |
$55,723.04 |
| Rate for Payer: BCBS Complete |
$55,723.04
|
| Rate for Payer: Mclaren Medicaid |
$53,069.56
|
| Rate for Payer: Meridian Medicaid |
$55,723.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$53,069.56
|
| Rate for Payer: UHC Medicaid |
$53,069.56
|
| Rate for Payer: UHCCP Medicaid |
$53,069.56
|
|
