|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$87.73
|
|
|
Service Code
|
NDC 00338050203
|
| Hospital Charge Code |
188047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.27 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Advantage |
$61.41
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.80
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: Priority Health SBD |
$55.27
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$72.50
|
|
|
Service Code
|
NDC 00338050206
|
| Hospital Charge Code |
188047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.67 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Aetna Commercial |
$61.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.12
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cofinity Advantage |
$50.75
|
| Rate for Payer: Cofinity Commercial |
$62.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.00
|
| Rate for Payer: Healthscope Commercial |
$65.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.38
|
| Rate for Payer: PHP Commercial |
$61.62
|
| Rate for Payer: Priority Health SBD |
$45.67
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$72.50
|
|
|
Service Code
|
NDC 00338050206
|
| Hospital Charge Code |
188047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Aetna Commercial |
$61.62
|
| Rate for Payer: Aetna Medicare |
$36.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.12
|
| Rate for Payer: BCBS Complete |
$29.00
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cofinity Advantage |
$50.75
|
| Rate for Payer: Cofinity Commercial |
$62.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.00
|
| Rate for Payer: Healthscope Commercial |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.38
|
| Rate for Payer: PHP Commercial |
$61.62
|
| Rate for Payer: Priority Health SBD |
$45.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.12
|
| Rate for Payer: UHC Core |
$37.77
|
| Rate for Payer: UHC Exchange |
$28.49
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$87.73
|
|
|
Service Code
|
NDC 00338050203
|
| Hospital Charge Code |
188047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.48 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: Aetna Medicare |
$43.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: BCBS Complete |
$35.09
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Advantage |
$61.41
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.80
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: Priority Health SBD |
$55.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.02
|
| Rate for Payer: UHC Core |
$45.71
|
| Rate for Payer: UHC Exchange |
$34.48
|
|
|
PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.53
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
31688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Commercial |
$13.81
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna Medicare |
$8.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: BCBS Complete |
$11.01
|
| Rate for Payer: BCBS Complete |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$2.41
|
| Rate for Payer: BCBS Trust/PPO |
$2.41
|
| Rate for Payer: BCN Commercial |
$2.41
|
| Rate for Payer: BCN Commercial |
$2.41
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cofinity Advantage |
$11.38
|
| Rate for Payer: Cofinity Advantage |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.00
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.65
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: PHP Commercial |
$13.81
|
| Rate for Payer: Priority Health SBD |
$10.24
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.60
|
| Rate for Payer: UHC Core |
$1.60
|
| Rate for Payer: UHC Core |
$1.60
|
| Rate for Payer: UHC Exchange |
$1.60
|
| Rate for Payer: UHC Exchange |
$1.60
|
|
|
PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.25
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
31688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.81
|
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cofinity Advantage |
$11.38
|
| Rate for Payer: Cofinity Advantage |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.00
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.65
|
| Rate for Payer: PHP Commercial |
$13.81
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: Priority Health SBD |
$10.24
|
| Rate for Payer: Priority Health SBD |
$17.34
|
|
|
PAROXETINE 20 MG TABLET
|
Facility
|
IP
|
$425.35
|
|
|
Service Code
|
NDC 00904567761
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$267.97 |
| Max. Negotiated Rate |
$382.81 |
| Rate for Payer: Aetna Commercial |
$361.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.48
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cofinity Advantage |
$297.75
|
| Rate for Payer: Cofinity Commercial |
$365.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Healthscope Commercial |
$382.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.01
|
| Rate for Payer: PHP Commercial |
$361.55
|
| Rate for Payer: Priority Health SBD |
$267.97
|
|
|
PAROXETINE 20 MG TABLET
|
Facility
|
IP
|
$321.95
|
|
|
Service Code
|
NDC 63739096310
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.83 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Aetna Commercial |
$273.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.27
|
| Rate for Payer: Cash Price |
$257.56
|
| Rate for Payer: Cofinity Advantage |
$225.37
|
| Rate for Payer: Cofinity Commercial |
$276.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.56
|
| Rate for Payer: Healthscope Commercial |
$289.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.46
|
| Rate for Payer: PHP Commercial |
$273.66
|
| Rate for Payer: Priority Health SBD |
$202.83
|
|
|
PAROXETINE 20 MG TABLET
|
Facility
|
OP
|
$321.95
|
|
|
Service Code
|
NDC 63739096310
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.53 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Aetna Commercial |
$273.66
|
| Rate for Payer: Aetna Medicare |
$160.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.27
|
| Rate for Payer: BCBS Complete |
$128.78
|
| Rate for Payer: Cash Price |
$257.56
|
| Rate for Payer: Cofinity Advantage |
$225.37
|
| Rate for Payer: Cofinity Commercial |
$276.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.56
|
| Rate for Payer: Healthscope Commercial |
$289.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.46
|
| Rate for Payer: PHP Commercial |
$273.66
|
| Rate for Payer: Priority Health SBD |
$202.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.27
|
| Rate for Payer: UHC Core |
$167.74
|
| Rate for Payer: UHC Exchange |
$126.53
|
|
|
PAROXETINE 20 MG TABLET
|
Facility
|
OP
|
$467.65
|
|
|
Service Code
|
NDC 68084004501
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.79 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare |
$233.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.97
|
| Rate for Payer: BCBS Complete |
$187.06
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Advantage |
$327.36
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.12
|
| Rate for Payer: Healthscope Commercial |
$420.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health SBD |
$294.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.97
|
| Rate for Payer: UHC Core |
$243.65
|
| Rate for Payer: UHC Exchange |
$183.79
|
|
|
PAROXETINE 20 MG TABLET
|
Facility
|
OP
|
$425.35
|
|
|
Service Code
|
NDC 00904567761
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.16 |
| Max. Negotiated Rate |
$382.81 |
| Rate for Payer: Aetna Commercial |
$361.55
|
| Rate for Payer: Aetna Medicare |
$212.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.48
|
| Rate for Payer: BCBS Complete |
$170.14
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cofinity Advantage |
$297.75
|
| Rate for Payer: Cofinity Commercial |
$365.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Healthscope Commercial |
$382.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$340.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.01
|
| Rate for Payer: PHP Commercial |
$361.55
|
| Rate for Payer: Priority Health SBD |
$267.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.48
|
| Rate for Payer: UHC Core |
$221.61
|
| Rate for Payer: UHC Exchange |
$167.16
|
|
|
PAROXETINE 20 MG TABLET
|
Facility
|
IP
|
$467.65
|
|
|
Service Code
|
NDC 68084004501
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$294.62 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.97
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Advantage |
$327.36
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.12
|
| Rate for Payer: Healthscope Commercial |
$420.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health SBD |
$294.62
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); PHALANX OF TOE
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 28124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.88 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$292.88
|
| Rate for Payer: BCN Commercial |
$292.88
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$1,705.10
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); TALUS OR CALCANEUS
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 28120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,492.20
|
| Rate for Payer: BCN Commercial |
$2,492.20
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$1,705.10
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); TARSAL OR METATARSAL BONE, EXCEPT TALUS OR CALCANEUS
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 28122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,037.70
|
| Rate for Payer: BCN Commercial |
$2,037.70
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$1,705.10
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
PARTIAL HYMENECTOMY OR REVISION OF HYMENAL RING
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 56700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,796.63
|
| Rate for Payer: BCN Commercial |
$1,796.63
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$3,196.15
|
|
|
Service Code
|
APR-DRG 8441
|
| Min. Negotiated Rate |
$3,043.95 |
| Max. Negotiated Rate |
$3,196.15 |
| Rate for Payer: BCBS Complete |
$3,196.15
|
| Rate for Payer: Mclaren Medicaid |
$3,043.95
|
| Rate for Payer: Meridian Medicaid |
$3,196.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,043.95
|
| Rate for Payer: UHC Medicaid |
$3,043.95
|
| Rate for Payer: UHCCP Medicaid |
$3,043.95
|
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$13,025.95
|
|
|
Service Code
|
APR-DRG 8444
|
| Min. Negotiated Rate |
$12,405.67 |
| Max. Negotiated Rate |
$13,025.95 |
| Rate for Payer: BCBS Complete |
$13,025.95
|
| Rate for Payer: Mclaren Medicaid |
$12,405.67
|
| Rate for Payer: Meridian Medicaid |
$13,025.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,405.67
|
| Rate for Payer: UHC Medicaid |
$12,405.67
|
| Rate for Payer: UHCCP Medicaid |
$12,405.67
|
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$5,783.45
|
|
|
Service Code
|
APR-DRG 8442
|
| Min. Negotiated Rate |
$5,508.05 |
| Max. Negotiated Rate |
$5,783.45 |
| Rate for Payer: BCBS Complete |
$5,783.45
|
| Rate for Payer: Mclaren Medicaid |
$5,508.05
|
| Rate for Payer: Meridian Medicaid |
$5,783.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,508.05
|
| Rate for Payer: UHC Medicaid |
$5,508.05
|
| Rate for Payer: UHCCP Medicaid |
$5,508.05
|
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$8,053.72
|
|
|
Service Code
|
APR-DRG 8443
|
| Min. Negotiated Rate |
$7,670.21 |
| Max. Negotiated Rate |
$8,053.72 |
| Rate for Payer: BCBS Complete |
$8,053.72
|
| Rate for Payer: Mclaren Medicaid |
$7,670.21
|
| Rate for Payer: Meridian Medicaid |
$8,053.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,670.21
|
| Rate for Payer: UHC Medicaid |
$7,670.21
|
| Rate for Payer: UHCCP Medicaid |
$7,670.21
|
|
|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC
|
Facility
|
IP
|
$23,473.54
|
|
|
Service Code
|
MSDRG 543
|
| Min. Negotiated Rate |
$8,097.42 |
| Max. Negotiated Rate |
$23,473.54 |
| Rate for Payer: Aetna Medicare |
$8,864.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,654.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,654.50
|
| Rate for Payer: BCBS MAPPO |
$8,523.60
|
| Rate for Payer: BCBS Trust/PPO |
$23,473.54
|
| Rate for Payer: BCN Commercial |
$23,473.54
|
| Rate for Payer: BCN Medicare Advantage |
$8,523.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,523.60
|
| Rate for Payer: Mclaren Medicare |
$8,523.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,949.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,802.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,375.96
|
| Rate for Payer: Nomi Health Commercial |
$13,261.20
|
| Rate for Payer: PACE Medicare |
$8,097.42
|
| Rate for Payer: PACE SWMI |
$8,523.60
|
| Rate for Payer: PHP Medicare Advantage |
$8,523.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,573.56
|
| Rate for Payer: Priority Health Medicare |
$8,523.60
|
| Rate for Payer: Priority Health Tiered Network |
$13,258.85
|
| Rate for Payer: Railroad Medicare Medicare |
$8,523.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,756.40
|
| Rate for Payer: UHC Core |
$14,018.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,523.60
|
| Rate for Payer: UHC Exchange |
$11,448.84
|
| Rate for Payer: VA VA |
$8,523.60
|
|
|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC
|
Facility
|
IP
|
$44,819.30
|
|
|
Service Code
|
MSDRG 542
|
| Min. Negotiated Rate |
$13,519.36 |
| Max. Negotiated Rate |
$44,819.30 |
| Rate for Payer: Aetna Medicare |
$14,800.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,788.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,788.64
|
| Rate for Payer: BCBS MAPPO |
$14,230.91
|
| Rate for Payer: BCBS Trust/PPO |
$44,819.30
|
| Rate for Payer: BCN Commercial |
$44,819.30
|
| Rate for Payer: BCN Medicare Advantage |
$14,230.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,230.91
|
| Rate for Payer: Mclaren Medicare |
$14,230.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,942.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,365.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,654.00
|
| Rate for Payer: Nomi Health Commercial |
$22,787.85
|
| Rate for Payer: PACE Medicare |
$13,519.36
|
| Rate for Payer: PACE SWMI |
$14,230.91
|
| Rate for Payer: PHP Medicare Advantage |
$14,230.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28,479.76
|
| Rate for Payer: Priority Health Medicare |
$14,230.91
|
| Rate for Payer: Priority Health Tiered Network |
$22,783.80
|
| Rate for Payer: Railroad Medicare Medicare |
$14,230.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,793.95
|
| Rate for Payer: UHC Core |
$24,089.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,230.91
|
| Rate for Payer: UHC Exchange |
$19,673.51
|
| Rate for Payer: VA VA |
$14,230.91
|
|
|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$17,438.96
|
|
|
Service Code
|
MSDRG 544
|
| Min. Negotiated Rate |
$6,090.19 |
| Max. Negotiated Rate |
$17,438.96 |
| Rate for Payer: Aetna Medicare |
$6,667.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,013.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,013.41
|
| Rate for Payer: BCBS MAPPO |
$6,410.73
|
| Rate for Payer: BCBS Trust/PPO |
$17,438.96
|
| Rate for Payer: BCN Commercial |
$17,438.96
|
| Rate for Payer: BCN Medicare Advantage |
$6,410.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,410.73
|
| Rate for Payer: Mclaren Medicare |
$6,410.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,731.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,372.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,051.80
|
| Rate for Payer: Nomi Health Commercial |
$9,734.34
|
| Rate for Payer: PACE Medicare |
$6,090.19
|
| Rate for Payer: PACE SWMI |
$6,410.73
|
| Rate for Payer: PHP Medicare Advantage |
$6,410.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,165.77
|
| Rate for Payer: Priority Health Medicare |
$6,410.73
|
| Rate for Payer: Priority Health Tiered Network |
$9,732.61
|
| Rate for Payer: Railroad Medicare Medicare |
$6,410.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,299.98
|
| Rate for Payer: UHC Core |
$10,290.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,410.73
|
| Rate for Payer: UHC Exchange |
$8,403.98
|
| Rate for Payer: VA VA |
$6,410.73
|
|
|
PEDS ECHO LIMITED W/DEFINITY
|
Facility
|
IP
|
$1,411.79
|
|
|
Service Code
|
HCPCS C8922
|
| Hospital Charge Code |
48000029
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$889.43 |
| Max. Negotiated Rate |
$1,270.61 |
| Rate for Payer: Aetna Commercial |
$1,200.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.66
|
| Rate for Payer: Cash Price |
$1,129.43
|
| Rate for Payer: Cofinity Advantage |
$988.25
|
| Rate for Payer: Cofinity Commercial |
$1,214.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,129.43
|
| Rate for Payer: Healthscope Commercial |
$1,270.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,058.84
|
| Rate for Payer: PHP Commercial |
$1,200.02
|
| Rate for Payer: Priority Health SBD |
$889.43
|
|
|
PEDS ECHO LIMITED W/DEFINITY
|
Facility
|
OP
|
$1,411.79
|
|
|
Service Code
|
HCPCS C8922
|
| Hospital Charge Code |
48000029
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$2,526.00 |
| Rate for Payer: Aetna Commercial |
$1,200.02
|
| Rate for Payer: Aetna Medicare |
$812.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,123.15
|
| Rate for Payer: BCN Commercial |
$1,123.15
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,129.43
|
| Rate for Payer: Cash Price |
$1,129.43
|
| Rate for Payer: Cofinity Advantage |
$988.25
|
| Rate for Payer: Cofinity Commercial |
$1,214.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,129.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$1,270.61
|
| Rate for Payer: Mclaren Medicaid |
$408.52
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$820.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.02
|
| Rate for Payer: Nomi Health Commercial |
$2,343.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,058.84
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$1,200.02
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,526.00
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health SBD |
$889.43
|
| Rate for Payer: Priority Health Tiered Network |
$2,020.80
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$917.66
|
| Rate for Payer: UHC Core |
$735.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$554.83
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
