|
ONDANSETRON HCL 4 MG TABLET
|
Facility
|
IP
|
$281.20
|
|
|
Service Code
|
NDC 00904655161
|
| Hospital Charge Code |
10778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.16 |
| Max. Negotiated Rate |
$253.08 |
| Rate for Payer: Aetna Commercial |
$239.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.78
|
| Rate for Payer: Cash Price |
$224.96
|
| Rate for Payer: Cofinity Advantage |
$196.84
|
| Rate for Payer: Cofinity Commercial |
$241.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.96
|
| Rate for Payer: Healthscope Commercial |
$253.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.90
|
| Rate for Payer: PHP Commercial |
$239.02
|
| Rate for Payer: Priority Health SBD |
$177.16
|
|
|
ONDANSETRON HCL 8 MG TABLET
|
Facility
|
OP
|
$240.96
|
|
|
Service Code
|
NDC 904655261
|
| Hospital Charge Code |
10779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.70 |
| Max. Negotiated Rate |
$216.86 |
| Rate for Payer: Aetna Commercial |
$204.82
|
| Rate for Payer: Aetna Medicare |
$120.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.62
|
| Rate for Payer: BCBS Complete |
$96.38
|
| Rate for Payer: Cash Price |
$192.77
|
| Rate for Payer: Cofinity Advantage |
$168.67
|
| Rate for Payer: Cofinity Commercial |
$207.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.77
|
| Rate for Payer: Healthscope Commercial |
$216.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.72
|
| Rate for Payer: PHP Commercial |
$204.82
|
| Rate for Payer: Priority Health SBD |
$151.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.62
|
| Rate for Payer: UHC Core |
$125.54
|
| Rate for Payer: UHC Exchange |
$94.70
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION (CODE)
|
Facility
|
OP
|
$13.95
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
163708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Medicare |
$6.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION (CODE)
|
Facility
|
IP
|
$13.95
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
163708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: Priority Health SBD |
$8.79
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION
|
Facility
|
OP
|
$15.43
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
105614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$13.89 |
| Rate for Payer: Aetna Commercial |
$13.12
|
| Rate for Payer: Aetna Commercial |
$10.33
|
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Commercial |
$11.05
|
| Rate for Payer: Aetna Commercial |
$4.76
|
| Rate for Payer: Aetna Commercial |
$8.12
|
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: Aetna Commercial |
$9.17
|
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Commercial |
$10.03
|
| Rate for Payer: Aetna Medicare |
$7.71
|
| Rate for Payer: Aetna Medicare |
$2.80
|
| Rate for Payer: Aetna Medicare |
$6.08
|
| Rate for Payer: Aetna Medicare |
$5.40
|
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna Medicare |
$5.90
|
| Rate for Payer: Aetna Medicare |
$6.97
|
| Rate for Payer: Aetna Medicare |
$5.12
|
| Rate for Payer: Aetna Medicare |
$4.78
|
| Rate for Payer: Aetna Medicare |
$5.83
|
| Rate for Payer: Aetna Medicare |
$4.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.66
|
| Rate for Payer: BCBS Complete |
$4.72
|
| Rate for Payer: BCBS Complete |
$4.32
|
| Rate for Payer: BCBS Complete |
$4.10
|
| Rate for Payer: BCBS Complete |
$6.17
|
| Rate for Payer: BCBS Complete |
$2.24
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS Complete |
$4.32
|
| Rate for Payer: BCBS Complete |
$5.20
|
| Rate for Payer: BCBS Complete |
$4.86
|
| Rate for Payer: BCBS Complete |
$3.40
|
| Rate for Payer: BCBS Complete |
$4.66
|
| Rate for Payer: BCBS Complete |
$3.82
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cash Price |
$7.64
|
| Rate for Payer: Cash Price |
$7.64
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Cash Price |
$9.44
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$9.44
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Advantage |
$8.51
|
| Rate for Payer: Cofinity Advantage |
$7.56
|
| Rate for Payer: Cofinity Advantage |
$7.55
|
| Rate for Payer: Cofinity Advantage |
$10.80
|
| Rate for Payer: Cofinity Advantage |
$9.10
|
| Rate for Payer: Cofinity Advantage |
$5.95
|
| Rate for Payer: Cofinity Advantage |
$7.17
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Advantage |
$6.68
|
| Rate for Payer: Cofinity Advantage |
$3.92
|
| Rate for Payer: Cofinity Advantage |
$8.26
|
| Rate for Payer: Cofinity Advantage |
$8.15
|
| Rate for Payer: Cofinity Commercial |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$8.81
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$10.02
|
| Rate for Payer: Cofinity Commercial |
$10.15
|
| Rate for Payer: Cofinity Commercial |
$10.45
|
| Rate for Payer: Cofinity Commercial |
$11.18
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$13.27
|
| Rate for Payer: Cofinity Commercial |
$4.82
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Cofinity Commercial |
$8.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$7.65
|
| Rate for Payer: Healthscope Commercial |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$10.94
|
| Rate for Payer: Healthscope Commercial |
$10.62
|
| Rate for Payer: Healthscope Commercial |
$10.48
|
| Rate for Payer: Healthscope Commercial |
$11.70
|
| Rate for Payer: Healthscope Commercial |
$9.22
|
| Rate for Payer: Healthscope Commercial |
$13.89
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$5.04
|
| Rate for Payer: Healthscope Commercial |
$8.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.74
|
| Rate for Payer: PHP Commercial |
$9.90
|
| Rate for Payer: PHP Commercial |
$8.12
|
| Rate for Payer: PHP Commercial |
$7.22
|
| Rate for Payer: PHP Commercial |
$10.33
|
| Rate for Payer: PHP Commercial |
$9.18
|
| Rate for Payer: PHP Commercial |
$11.05
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$8.70
|
| Rate for Payer: PHP Commercial |
$4.76
|
| Rate for Payer: PHP Commercial |
$10.03
|
| Rate for Payer: PHP Commercial |
$13.12
|
| Rate for Payer: PHP Commercial |
$9.17
|
| Rate for Payer: Priority Health SBD |
$7.65
|
| Rate for Payer: Priority Health SBD |
$7.43
|
| Rate for Payer: Priority Health SBD |
$8.19
|
| Rate for Payer: Priority Health SBD |
$7.34
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: Priority Health SBD |
$9.72
|
| Rate for Payer: Priority Health SBD |
$6.80
|
| Rate for Payer: Priority Health SBD |
$6.80
|
| Rate for Payer: Priority Health SBD |
$6.45
|
| Rate for Payer: Priority Health SBD |
$3.53
|
| Rate for Payer: Priority Health SBD |
$5.36
|
| Rate for Payer: Priority Health SBD |
$6.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$9.55
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
105614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$8.60 |
| Rate for Payer: Aetna Commercial |
$8.12
|
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: Aetna Commercial |
$10.03
|
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Commercial |
$10.33
|
| Rate for Payer: Aetna Commercial |
$13.12
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Commercial |
$11.05
|
| Rate for Payer: Aetna Commercial |
$4.76
|
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: Aetna Commercial |
$9.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.57
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cash Price |
$9.44
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Cash Price |
$7.64
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cofinity Advantage |
$3.92
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Advantage |
$8.51
|
| Rate for Payer: Cofinity Advantage |
$7.17
|
| Rate for Payer: Cofinity Advantage |
$6.68
|
| Rate for Payer: Cofinity Advantage |
$10.80
|
| Rate for Payer: Cofinity Advantage |
$5.95
|
| Rate for Payer: Cofinity Advantage |
$8.15
|
| Rate for Payer: Cofinity Advantage |
$9.10
|
| Rate for Payer: Cofinity Advantage |
$8.26
|
| Rate for Payer: Cofinity Advantage |
$7.55
|
| Rate for Payer: Cofinity Advantage |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$8.81
|
| Rate for Payer: Cofinity Commercial |
$9.28
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$4.82
|
| Rate for Payer: Cofinity Commercial |
$13.27
|
| Rate for Payer: Cofinity Commercial |
$11.18
|
| Rate for Payer: Cofinity Commercial |
$10.15
|
| Rate for Payer: Cofinity Commercial |
$10.02
|
| Rate for Payer: Cofinity Commercial |
$10.45
|
| Rate for Payer: Cofinity Commercial |
$8.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.64
|
| Rate for Payer: Healthscope Commercial |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$10.48
|
| Rate for Payer: Healthscope Commercial |
$7.65
|
| Rate for Payer: Healthscope Commercial |
$10.94
|
| Rate for Payer: Healthscope Commercial |
$5.04
|
| Rate for Payer: Healthscope Commercial |
$11.70
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$8.60
|
| Rate for Payer: Healthscope Commercial |
$9.22
|
| Rate for Payer: Healthscope Commercial |
$10.62
|
| Rate for Payer: Healthscope Commercial |
$13.89
|
| Rate for Payer: Healthscope Commercial |
$9.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.38
|
| Rate for Payer: PHP Commercial |
$9.90
|
| Rate for Payer: PHP Commercial |
$8.70
|
| Rate for Payer: PHP Commercial |
$10.33
|
| Rate for Payer: PHP Commercial |
$9.17
|
| Rate for Payer: PHP Commercial |
$10.03
|
| Rate for Payer: PHP Commercial |
$13.12
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$9.18
|
| Rate for Payer: PHP Commercial |
$11.05
|
| Rate for Payer: PHP Commercial |
$7.22
|
| Rate for Payer: PHP Commercial |
$8.12
|
| Rate for Payer: PHP Commercial |
$4.76
|
| Rate for Payer: Priority Health SBD |
$7.43
|
| Rate for Payer: Priority Health SBD |
$3.53
|
| Rate for Payer: Priority Health SBD |
$9.72
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: Priority Health SBD |
$5.36
|
| Rate for Payer: Priority Health SBD |
$6.80
|
| Rate for Payer: Priority Health SBD |
$7.34
|
| Rate for Payer: Priority Health SBD |
$8.19
|
| Rate for Payer: Priority Health SBD |
$6.02
|
| Rate for Payer: Priority Health SBD |
$7.65
|
| Rate for Payer: Priority Health SBD |
$6.80
|
| Rate for Payer: Priority Health SBD |
$6.45
|
|
|
OPEN CRANIOTOMY EXCEPT TRAUMA
|
Facility
|
IP
|
$31,258.61
|
|
|
Service Code
|
APR-DRG 0214
|
| Min. Negotiated Rate |
$29,770.10 |
| Max. Negotiated Rate |
$31,258.61 |
| Rate for Payer: BCBS Complete |
$31,258.61
|
| Rate for Payer: Mclaren Medicaid |
$29,770.10
|
| Rate for Payer: Meridian Medicaid |
$31,258.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$29,770.10
|
| Rate for Payer: UHC Medicaid |
$29,770.10
|
| Rate for Payer: UHCCP Medicaid |
$29,770.10
|
|
|
OPEN CRANIOTOMY EXCEPT TRAUMA
|
Facility
|
IP
|
$21,353.71
|
|
|
Service Code
|
APR-DRG 0212
|
| Min. Negotiated Rate |
$20,336.86 |
| Max. Negotiated Rate |
$21,353.71 |
| Rate for Payer: BCBS Complete |
$21,353.71
|
| Rate for Payer: Mclaren Medicaid |
$20,336.86
|
| Rate for Payer: Meridian Medicaid |
$21,353.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,336.86
|
| Rate for Payer: UHC Medicaid |
$20,336.86
|
| Rate for Payer: UHCCP Medicaid |
$20,336.86
|
|
|
OPEN CRANIOTOMY EXCEPT TRAUMA
|
Facility
|
IP
|
$13,987.37
|
|
|
Service Code
|
APR-DRG 0211
|
| Min. Negotiated Rate |
$13,321.31 |
| Max. Negotiated Rate |
$13,987.37 |
| Rate for Payer: BCBS Complete |
$13,987.37
|
| Rate for Payer: Mclaren Medicaid |
$13,321.31
|
| Rate for Payer: Meridian Medicaid |
$13,987.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,321.31
|
| Rate for Payer: UHC Medicaid |
$13,321.31
|
| Rate for Payer: UHCCP Medicaid |
$13,321.31
|
|
|
OPEN CRANIOTOMY EXCEPT TRAUMA
|
Facility
|
IP
|
$27,749.44
|
|
|
Service Code
|
APR-DRG 0213
|
| Min. Negotiated Rate |
$26,428.04 |
| Max. Negotiated Rate |
$27,749.44 |
| Rate for Payer: BCBS Complete |
$27,749.44
|
| Rate for Payer: Mclaren Medicaid |
$26,428.04
|
| Rate for Payer: Meridian Medicaid |
$27,749.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$26,428.04
|
| Rate for Payer: UHC Medicaid |
$26,428.04
|
| Rate for Payer: UHCCP Medicaid |
$26,428.04
|
|
|
OPEN CRANIOTOMY FOR TRAUMA
|
Facility
|
IP
|
$10,021.28
|
|
|
Service Code
|
APR-DRG 0201
|
| Min. Negotiated Rate |
$9,544.08 |
| Max. Negotiated Rate |
$10,021.28 |
| Rate for Payer: BCBS Complete |
$10,021.28
|
| Rate for Payer: Mclaren Medicaid |
$9,544.08
|
| Rate for Payer: Meridian Medicaid |
$10,021.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,544.08
|
| Rate for Payer: UHC Medicaid |
$9,544.08
|
| Rate for Payer: UHCCP Medicaid |
$9,544.08
|
|
|
OPEN CRANIOTOMY FOR TRAUMA
|
Facility
|
IP
|
$15,424.64
|
|
|
Service Code
|
APR-DRG 0202
|
| Min. Negotiated Rate |
$14,690.13 |
| Max. Negotiated Rate |
$15,424.64 |
| Rate for Payer: BCBS Complete |
$15,424.64
|
| Rate for Payer: Mclaren Medicaid |
$14,690.13
|
| Rate for Payer: Meridian Medicaid |
$15,424.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,690.13
|
| Rate for Payer: UHC Medicaid |
$14,690.13
|
| Rate for Payer: UHCCP Medicaid |
$14,690.13
|
|
|
OPEN CRANIOTOMY FOR TRAUMA
|
Facility
|
IP
|
$24,845.10
|
|
|
Service Code
|
APR-DRG 0203
|
| Min. Negotiated Rate |
$23,662.00 |
| Max. Negotiated Rate |
$24,845.10 |
| Rate for Payer: BCBS Complete |
$24,845.10
|
| Rate for Payer: Mclaren Medicaid |
$23,662.00
|
| Rate for Payer: Meridian Medicaid |
$24,845.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,662.00
|
| Rate for Payer: UHC Medicaid |
$23,662.00
|
| Rate for Payer: UHCCP Medicaid |
$23,662.00
|
|
|
OPEN CRANIOTOMY FOR TRAUMA
|
Facility
|
IP
|
$38,556.14
|
|
|
Service Code
|
APR-DRG 0204
|
| Min. Negotiated Rate |
$36,720.14 |
| Max. Negotiated Rate |
$38,556.14 |
| Rate for Payer: BCBS Complete |
$38,556.14
|
| Rate for Payer: Mclaren Medicaid |
$36,720.14
|
| Rate for Payer: Meridian Medicaid |
$38,556.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$36,720.14
|
| Rate for Payer: UHC Medicaid |
$36,720.14
|
| Rate for Payer: UHCCP Medicaid |
$36,720.14
|
|
|
OPEN EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$9,777.63
|
|
|
Service Code
|
APR-DRG 0242
|
| Min. Negotiated Rate |
$9,312.03 |
| Max. Negotiated Rate |
$9,777.63 |
| Rate for Payer: BCBS Complete |
$9,777.63
|
| Rate for Payer: Mclaren Medicaid |
$9,312.03
|
| Rate for Payer: Meridian Medicaid |
$9,777.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,312.03
|
| Rate for Payer: UHC Medicaid |
$9,312.03
|
| Rate for Payer: UHCCP Medicaid |
$9,312.03
|
|
|
OPEN EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$13,882.46
|
|
|
Service Code
|
APR-DRG 0243
|
| Min. Negotiated Rate |
$13,221.39 |
| Max. Negotiated Rate |
$13,882.46 |
| Rate for Payer: BCBS Complete |
$13,882.46
|
| Rate for Payer: Mclaren Medicaid |
$13,221.39
|
| Rate for Payer: Meridian Medicaid |
$13,882.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,221.39
|
| Rate for Payer: UHC Medicaid |
$13,221.39
|
| Rate for Payer: UHCCP Medicaid |
$13,221.39
|
|
|
OPEN EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$21,200.63
|
|
|
Service Code
|
APR-DRG 0244
|
| Min. Negotiated Rate |
$20,191.08 |
| Max. Negotiated Rate |
$21,200.63 |
| Rate for Payer: BCBS Complete |
$21,200.63
|
| Rate for Payer: Mclaren Medicaid |
$20,191.08
|
| Rate for Payer: Meridian Medicaid |
$21,200.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,191.08
|
| Rate for Payer: UHC Medicaid |
$20,191.08
|
| Rate for Payer: UHCCP Medicaid |
$20,191.08
|
|
|
OPEN EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$5,996.72
|
|
|
Service Code
|
APR-DRG 0241
|
| Min. Negotiated Rate |
$5,711.16 |
| Max. Negotiated Rate |
$5,996.72 |
| Rate for Payer: BCBS Complete |
$5,996.72
|
| Rate for Payer: Mclaren Medicaid |
$5,711.16
|
| Rate for Payer: Meridian Medicaid |
$5,996.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,711.16
|
| Rate for Payer: UHC Medicaid |
$5,711.16
|
| Rate for Payer: UHCCP Medicaid |
$5,711.16
|
|
|
OPEN IMPLANTATION OF CRANIAL NERVE (EG, VAGUS NERVE) NEUROSTIMULATOR ELECTRODE ARRAY AND PULSE GENERATOR
|
Facility
|
OP
|
$131,664.27
|
|
|
Service Code
|
CPT 64568
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$17,351.09 |
| Max. Negotiated Rate |
$131,664.27 |
| Rate for Payer: Aetna Medicare |
$45,643.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54,860.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54,860.11
|
| Rate for Payer: BCBS Complete |
$24,103.34
|
| Rate for Payer: BCBS MAPPO |
$43,888.09
|
| Rate for Payer: BCBS Trust/PPO |
$17,351.09
|
| Rate for Payer: BCN Commercial |
$17,351.09
|
| Rate for Payer: BCN Medicare Advantage |
$43,888.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43,888.09
|
| Rate for Payer: Mclaren Medicaid |
$22,953.47
|
| Rate for Payer: Mclaren Medicare |
$43,888.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46,082.49
|
| Rate for Payer: Meridian Medicaid |
$46,082.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50,471.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$48,276.90
|
| Rate for Payer: Nomi Health Commercial |
$131,664.27
|
| Rate for Payer: PACE Medicare |
$41,693.69
|
| Rate for Payer: PACE SWMI |
$43,888.09
|
| Rate for Payer: PHP Medicare Advantage |
$43,888.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,953.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$45,000.50
|
| Rate for Payer: Priority Health Medicare |
$43,888.09
|
| Rate for Payer: Priority Health Tiered Network |
$36,000.40
|
| Rate for Payer: Railroad Medicare Medicare |
$43,888.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$43,888.09
|
| Rate for Payer: UHC Medicaid |
$22,953.47
|
| Rate for Payer: UHCCP Medicaid |
$22,953.47
|
| Rate for Payer: VA VA |
$43,888.09
|
|
|
OPEN IMPLANTATION OF HYPOGLOSSAL NERVE NEUROSTIMULATOR ARRAY, PULSE GENERATOR, AND DISTAL RESPIRATORY SENSOR ELECTRODE OR ELECTRODE ARRAY
|
Facility
|
OP
|
$99,432.20
|
|
|
Service Code
|
CPT 64582
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,080.55 |
| Max. Negotiated Rate |
$99,432.20 |
| Rate for Payer: Aetna Medicare |
$31,976.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,433.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,433.43
|
| Rate for Payer: BCBS Complete |
$16,886.11
|
| Rate for Payer: BCBS MAPPO |
$30,746.74
|
| Rate for Payer: BCBS Trust/PPO |
$30,095.12
|
| Rate for Payer: BCN Commercial |
$30,095.12
|
| Rate for Payer: BCN Medicare Advantage |
$30,746.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,746.74
|
| Rate for Payer: Mclaren Medicaid |
$16,080.55
|
| Rate for Payer: Mclaren Medicare |
$30,746.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32,284.08
|
| Rate for Payer: Meridian Medicaid |
$32,284.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,358.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$33,821.41
|
| Rate for Payer: Nomi Health Commercial |
$92,240.22
|
| Rate for Payer: PACE Medicare |
$29,209.40
|
| Rate for Payer: PACE SWMI |
$30,746.74
|
| Rate for Payer: PHP Medicare Advantage |
$30,746.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,080.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$99,432.20
|
| Rate for Payer: Priority Health Medicare |
$30,746.74
|
| Rate for Payer: Priority Health Tiered Network |
$79,545.76
|
| Rate for Payer: Railroad Medicare Medicare |
$30,746.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30,746.74
|
| Rate for Payer: UHC Medicaid |
$16,080.55
|
| Rate for Payer: UHCCP Medicaid |
$16,080.55
|
| Rate for Payer: VA VA |
$30,746.74
|
|
|
OPEN TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL AND MEDIAL MALLEOLI, OR LATERAL AND POSTERIOR MALLEOLI, OR MEDIAL AND POSTERIOR MALLEOLI), INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 27814
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,269.95
|
| Rate for Payer: BCN Commercial |
$4,269.95
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$3,781.35
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
OPEN TREATMENT OF CLAVICULAR FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 23515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,738.95
|
| Rate for Payer: BCN Commercial |
$4,738.95
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$3,781.35
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
OPEN TREATMENT OF DEPRESSED ZYGOMATIC ARCH FRACTURE (EG, GILLIES APPROACH)
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 21356
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,333.81 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,333.81
|
| Rate for Payer: BCN Commercial |
$2,333.81
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$3,084.94
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
OPEN TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS), INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 27792
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,794.67
|
| Rate for Payer: BCN Commercial |
$3,794.67
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$3,781.35
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION; WITH INTERNAL FIXATION OF 3 OR MORE FRAGMENTS
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 25609
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$5,131.19
|
| Rate for Payer: BCN Commercial |
$5,131.19
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$3,781.35
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
