|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$5,504.83
|
|
|
Service Code
|
APR-DRG 7212
|
| Min. Negotiated Rate |
$5,242.69 |
| Max. Negotiated Rate |
$5,504.83 |
| Rate for Payer: BCBS Complete |
$5,504.83
|
| Rate for Payer: Mclaren Medicaid |
$5,242.69
|
| Rate for Payer: Meridian Medicaid |
$5,504.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,242.69
|
| Rate for Payer: UHC Medicaid |
$5,242.69
|
| Rate for Payer: UHCCP Medicaid |
$5,242.69
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$3,996.47
|
|
|
Service Code
|
APR-DRG 7211
|
| Min. Negotiated Rate |
$3,806.17 |
| Max. Negotiated Rate |
$3,996.47 |
| Rate for Payer: BCBS Complete |
$3,996.47
|
| Rate for Payer: Mclaren Medicaid |
$3,806.17
|
| Rate for Payer: Meridian Medicaid |
$3,996.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,806.17
|
| Rate for Payer: UHC Medicaid |
$3,806.17
|
| Rate for Payer: UHCCP Medicaid |
$3,806.17
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$9,367.72
|
|
|
Service Code
|
APR-DRG 7213
|
| Min. Negotiated Rate |
$8,921.64 |
| Max. Negotiated Rate |
$9,367.72 |
| Rate for Payer: BCBS Complete |
$9,367.72
|
| Rate for Payer: Mclaren Medicaid |
$8,921.64
|
| Rate for Payer: Meridian Medicaid |
$9,367.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,921.64
|
| Rate for Payer: UHC Medicaid |
$8,921.64
|
| Rate for Payer: UHCCP Medicaid |
$8,921.64
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$13,958.71
|
|
|
Service Code
|
APR-DRG 7214
|
| Min. Negotiated Rate |
$13,294.01 |
| Max. Negotiated Rate |
$13,958.71 |
| Rate for Payer: BCBS Complete |
$13,958.71
|
| Rate for Payer: Mclaren Medicaid |
$13,294.01
|
| Rate for Payer: Meridian Medicaid |
$13,958.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,294.01
|
| Rate for Payer: UHC Medicaid |
$13,294.01
|
| Rate for Payer: UHCCP Medicaid |
$13,294.01
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES
|
Facility
|
IP
|
$27,853.18
|
|
|
Service Code
|
MSDRG 769
|
| Min. Negotiated Rate |
$12,956.26 |
| Max. Negotiated Rate |
$27,853.18 |
| Rate for Payer: Aetna Medicare |
$14,183.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,047.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,047.71
|
| Rate for Payer: BCBS MAPPO |
$13,638.17
|
| Rate for Payer: BCBS Trust/PPO |
$27,853.18
|
| Rate for Payer: BCN Commercial |
$27,853.18
|
| Rate for Payer: BCN Medicare Advantage |
$13,638.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,638.17
|
| Rate for Payer: Mclaren Medicare |
$13,638.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,320.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,683.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,001.99
|
| Rate for Payer: Nomi Health Commercial |
$21,798.42
|
| Rate for Payer: PACE Medicare |
$12,956.26
|
| Rate for Payer: PACE SWMI |
$13,638.17
|
| Rate for Payer: PHP Medicare Advantage |
$13,638.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,834.64
|
| Rate for Payer: Priority Health Medicare |
$13,638.17
|
| Rate for Payer: Priority Health Tiered Network |
$16,667.71
|
| Rate for Payer: Railroad Medicare Medicare |
$13,638.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,543.74
|
| Rate for Payer: UHC Core |
$23,043.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,638.17
|
| Rate for Payer: UHC Exchange |
$18,819.30
|
| Rate for Payer: VA VA |
$13,638.17
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES
|
Facility
|
IP
|
$10,671.61
|
|
|
Service Code
|
MSDRG 776
|
| Min. Negotiated Rate |
$5,356.76 |
| Max. Negotiated Rate |
$10,671.61 |
| Rate for Payer: Aetna Medicare |
$5,864.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,048.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,048.36
|
| Rate for Payer: BCBS MAPPO |
$5,638.69
|
| Rate for Payer: BCBS Trust/PPO |
$7,638.03
|
| Rate for Payer: BCN Commercial |
$7,638.03
|
| Rate for Payer: BCN Medicare Advantage |
$5,638.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,638.69
|
| Rate for Payer: Mclaren Medicare |
$5,638.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,920.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,484.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,202.56
|
| Rate for Payer: Nomi Health Commercial |
$8,445.63
|
| Rate for Payer: PACE Medicare |
$5,356.76
|
| Rate for Payer: PACE SWMI |
$5,638.69
|
| Rate for Payer: PHP Medicare Advantage |
$5,638.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,982.83
|
| Rate for Payer: Priority Health Medicare |
$5,638.69
|
| Rate for Payer: Priority Health Tiered Network |
$7,986.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,638.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,671.61
|
| Rate for Payer: UHC Core |
$8,928.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,638.69
|
| Rate for Payer: UHC Exchange |
$7,291.39
|
| Rate for Payer: VA VA |
$5,638.69
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$2,741.52
|
|
|
Service Code
|
APR-DRG 5612
|
| Min. Negotiated Rate |
$2,610.97 |
| Max. Negotiated Rate |
$2,741.52 |
| Rate for Payer: BCBS Complete |
$2,741.52
|
| Rate for Payer: Mclaren Medicaid |
$2,610.97
|
| Rate for Payer: Meridian Medicaid |
$2,741.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,610.97
|
| Rate for Payer: UHC Medicaid |
$2,610.97
|
| Rate for Payer: UHCCP Medicaid |
$2,610.97
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$4,922.35
|
|
|
Service Code
|
APR-DRG 5613
|
| Min. Negotiated Rate |
$4,687.96 |
| Max. Negotiated Rate |
$4,922.35 |
| Rate for Payer: BCBS Complete |
$4,922.35
|
| Rate for Payer: Mclaren Medicaid |
$4,687.96
|
| Rate for Payer: Meridian Medicaid |
$4,922.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,687.96
|
| Rate for Payer: UHC Medicaid |
$4,687.96
|
| Rate for Payer: UHCCP Medicaid |
$4,687.96
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$1,722.77
|
|
|
Service Code
|
APR-DRG 5611
|
| Min. Negotiated Rate |
$1,640.73 |
| Max. Negotiated Rate |
$1,722.77 |
| Rate for Payer: BCBS Complete |
$1,722.77
|
| Rate for Payer: Mclaren Medicaid |
$1,640.73
|
| Rate for Payer: Meridian Medicaid |
$1,722.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,640.73
|
| Rate for Payer: UHC Medicaid |
$1,640.73
|
| Rate for Payer: UHCCP Medicaid |
$1,640.73
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$9,922.10
|
|
|
Service Code
|
APR-DRG 5614
|
| Min. Negotiated Rate |
$9,449.62 |
| Max. Negotiated Rate |
$9,922.10 |
| Rate for Payer: BCBS Complete |
$9,922.10
|
| Rate for Payer: Mclaren Medicaid |
$9,449.62
|
| Rate for Payer: Meridian Medicaid |
$9,922.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,449.62
|
| Rate for Payer: UHC Medicaid |
$9,449.62
|
| Rate for Payer: UHCCP Medicaid |
$9,449.62
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$16,988.03
|
|
|
Service Code
|
APR-DRG 5484
|
| Min. Negotiated Rate |
$16,179.07 |
| Max. Negotiated Rate |
$16,988.03 |
| Rate for Payer: BCBS Complete |
$16,988.03
|
| Rate for Payer: Mclaren Medicaid |
$16,179.07
|
| Rate for Payer: Meridian Medicaid |
$16,988.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,179.07
|
| Rate for Payer: UHC Medicaid |
$16,179.07
|
| Rate for Payer: UHCCP Medicaid |
$16,179.07
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$5,682.55
|
|
|
Service Code
|
APR-DRG 5482
|
| Min. Negotiated Rate |
$5,411.95 |
| Max. Negotiated Rate |
$5,682.55 |
| Rate for Payer: BCBS Complete |
$5,682.55
|
| Rate for Payer: Mclaren Medicaid |
$5,411.95
|
| Rate for Payer: Meridian Medicaid |
$5,682.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,411.95
|
| Rate for Payer: UHC Medicaid |
$5,411.95
|
| Rate for Payer: UHCCP Medicaid |
$5,411.95
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$9,136.68
|
|
|
Service Code
|
APR-DRG 5483
|
| Min. Negotiated Rate |
$8,701.60 |
| Max. Negotiated Rate |
$9,136.68 |
| Rate for Payer: BCBS Complete |
$9,136.68
|
| Rate for Payer: Mclaren Medicaid |
$8,701.60
|
| Rate for Payer: Meridian Medicaid |
$9,136.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,701.60
|
| Rate for Payer: UHC Medicaid |
$8,701.60
|
| Rate for Payer: UHCCP Medicaid |
$8,701.60
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$2,292.05
|
|
|
Service Code
|
APR-DRG 5481
|
| Min. Negotiated Rate |
$2,182.91 |
| Max. Negotiated Rate |
$2,292.05 |
| Rate for Payer: BCBS Complete |
$2,292.05
|
| Rate for Payer: Mclaren Medicaid |
$2,182.91
|
| Rate for Payer: Meridian Medicaid |
$2,292.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,182.91
|
| Rate for Payer: UHC Medicaid |
$2,182.91
|
| Rate for Payer: UHCCP Medicaid |
$2,182.91
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$40.50
|
|
|
Service Code
|
NDC 00409329415
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Medicare |
$20.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: BCBS Complete |
$16.20
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Advantage |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.38
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.32
|
| Rate for Payer: UHC Core |
$21.10
|
| Rate for Payer: UHC Exchange |
$15.92
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$40.50
|
|
|
Service Code
|
NDC 00409329425
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Advantage |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.38
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health SBD |
$25.52
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.92
|
|
|
Service Code
|
NDC 00409329461
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$22.43 |
| Rate for Payer: Aetna Commercial |
$21.18
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.20
|
| Rate for Payer: BCBS Complete |
$9.97
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cofinity Advantage |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$21.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.94
|
| Rate for Payer: Healthscope Commercial |
$22.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.69
|
| Rate for Payer: PHP Commercial |
$21.18
|
| Rate for Payer: Priority Health SBD |
$15.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.20
|
| Rate for Payer: UHC Core |
$12.98
|
| Rate for Payer: UHC Exchange |
$9.79
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.92
|
|
|
Service Code
|
NDC 00409329461
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.70 |
| Max. Negotiated Rate |
$22.43 |
| Rate for Payer: Aetna Commercial |
$21.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.20
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cofinity Advantage |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$21.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.94
|
| Rate for Payer: Healthscope Commercial |
$22.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.69
|
| Rate for Payer: PHP Commercial |
$21.18
|
| Rate for Payer: Priority Health SBD |
$15.70
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.92
|
|
|
Service Code
|
NDC 00409329451
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.70 |
| Max. Negotiated Rate |
$22.43 |
| Rate for Payer: Aetna Commercial |
$21.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.20
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cofinity Advantage |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$21.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.94
|
| Rate for Payer: Healthscope Commercial |
$22.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.69
|
| Rate for Payer: PHP Commercial |
$21.18
|
| Rate for Payer: Priority Health SBD |
$15.70
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.92
|
|
|
Service Code
|
NDC 00409329451
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$22.43 |
| Rate for Payer: Aetna Commercial |
$21.18
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.20
|
| Rate for Payer: BCBS Complete |
$9.97
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cofinity Advantage |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$21.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.94
|
| Rate for Payer: Healthscope Commercial |
$22.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.69
|
| Rate for Payer: PHP Commercial |
$21.18
|
| Rate for Payer: Priority Health SBD |
$15.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.20
|
| Rate for Payer: UHC Core |
$12.98
|
| Rate for Payer: UHC Exchange |
$9.79
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$40.50
|
|
|
Service Code
|
NDC 00409329415
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Advantage |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.38
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health SBD |
$25.52
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$40.50
|
|
|
Service Code
|
NDC 00409329425
|
| Hospital Charge Code |
6420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Medicare |
$20.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: BCBS Complete |
$16.20
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Advantage |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.38
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.32
|
| Rate for Payer: UHC Core |
$21.10
|
| Rate for Payer: UHC Exchange |
$15.92
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
IP
|
$32.71
|
|
|
Service Code
|
NDC 09900001917
|
| Hospital Charge Code |
300443
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.61 |
| Max. Negotiated Rate |
$29.44 |
| Rate for Payer: Aetna Commercial |
$27.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.26
|
| Rate for Payer: Cash Price |
$26.17
|
| Rate for Payer: Cofinity Advantage |
$22.90
|
| Rate for Payer: Cofinity Commercial |
$28.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.17
|
| Rate for Payer: Healthscope Commercial |
$29.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.53
|
| Rate for Payer: PHP Commercial |
$27.80
|
| Rate for Payer: Priority Health SBD |
$20.61
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
OP
|
$32.71
|
|
|
Service Code
|
NDC 09900001917
|
| Hospital Charge Code |
300443
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$29.44 |
| Rate for Payer: Aetna Commercial |
$27.80
|
| Rate for Payer: Aetna Medicare |
$16.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.26
|
| Rate for Payer: BCBS Complete |
$13.08
|
| Rate for Payer: Cash Price |
$26.17
|
| Rate for Payer: Cofinity Advantage |
$22.90
|
| Rate for Payer: Cofinity Commercial |
$28.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.17
|
| Rate for Payer: Healthscope Commercial |
$29.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.53
|
| Rate for Payer: PHP Commercial |
$27.80
|
| Rate for Payer: Priority Health SBD |
$20.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.26
|
| Rate for Payer: UHC Core |
$17.04
|
| Rate for Payer: UHC Exchange |
$12.86
|
|
|
POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$83.91
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
11076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.86 |
| Max. Negotiated Rate |
$75.52 |
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna Commercial |
$128.58
|
| Rate for Payer: Aetna Commercial |
$47.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.54
|
| Rate for Payer: Cash Price |
$121.02
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cash Price |
$67.13
|
| Rate for Payer: Cofinity Advantage |
$39.08
|
| Rate for Payer: Cofinity Advantage |
$52.48
|
| Rate for Payer: Cofinity Advantage |
$58.74
|
| Rate for Payer: Cofinity Advantage |
$105.89
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Cofinity Commercial |
$48.01
|
| Rate for Payer: Cofinity Commercial |
$72.16
|
| Rate for Payer: Cofinity Commercial |
$130.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.13
|
| Rate for Payer: Healthscope Commercial |
$136.14
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Healthscope Commercial |
$50.25
|
| Rate for Payer: Healthscope Commercial |
$75.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.93
|
| Rate for Payer: PHP Commercial |
$47.46
|
| Rate for Payer: PHP Commercial |
$128.58
|
| Rate for Payer: PHP Commercial |
$71.32
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: Priority Health SBD |
$47.23
|
| Rate for Payer: Priority Health SBD |
$35.17
|
| Rate for Payer: Priority Health SBD |
$52.86
|
| Rate for Payer: Priority Health SBD |
$95.30
|
|
