|
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC
|
Facility
IP
|
$13,518.09
|
|
|
Service Code
|
MS-DRG 087
|
| Min. Negotiated Rate |
$6,531.21 |
| Max. Negotiated Rate |
$13,518.09 |
| Rate for Payer: Aetna Medicare |
$7,149.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,593.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,593.70
|
| Rate for Payer: BCBS MAPPO |
$6,874.96
|
| Rate for Payer: BCBS Trust/PPO |
$13,397.19
|
| Rate for Payer: BCN Medicare Advantage |
$6,874.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,874.96
|
| Rate for Payer: Mclaren Medicare |
$6,874.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,218.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,906.20
|
| Rate for Payer: PACE Medicare |
$6,531.21
|
| Rate for Payer: PACE SWMI |
$6,874.96
|
| Rate for Payer: PHP Medicare Advantage |
$6,874.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,716.90
|
| Rate for Payer: Priority Health Medicare |
$6,874.96
|
| Rate for Payer: Priority Health Narrow Network |
$10,173.52
|
| Rate for Payer: Railroad Medicare Medicare |
$6,874.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,518.09
|
| Rate for Payer: UHC Core |
$8,294.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,874.96
|
| Rate for Payer: UHC Exchange |
$8,884.16
|
| Rate for Payer: UHC Medicare Advantage |
$7,081.21
|
| Rate for Payer: VA VA |
$6,874.96
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC
|
Facility
IP
|
$15,221.98
|
|
|
Service Code
|
MS-DRG 084
|
| Min. Negotiated Rate |
$6,760.41 |
| Max. Negotiated Rate |
$15,221.98 |
| Rate for Payer: Aetna Medicare |
$7,400.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,895.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,895.28
|
| Rate for Payer: BCBS MAPPO |
$7,116.22
|
| Rate for Payer: BCBS Trust/PPO |
$15,221.98
|
| Rate for Payer: BCN Medicare Advantage |
$7,116.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,116.22
|
| Rate for Payer: Mclaren Medicare |
$7,116.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,472.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,183.65
|
| Rate for Payer: PACE Medicare |
$6,760.41
|
| Rate for Payer: PACE SWMI |
$7,116.22
|
| Rate for Payer: PHP Medicare Advantage |
$7,116.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,197.62
|
| Rate for Payer: Priority Health Medicare |
$7,116.22
|
| Rate for Payer: Priority Health Narrow Network |
$10,558.10
|
| Rate for Payer: Railroad Medicare Medicare |
$7,116.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,029.10
|
| Rate for Payer: UHC Core |
$8,608.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,116.22
|
| Rate for Payer: UHC Exchange |
$9,219.99
|
| Rate for Payer: UHC Medicare Advantage |
$7,329.71
|
| Rate for Payer: VA VA |
$7,116.22
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC
|
Facility
IP
|
$22,975.57
|
|
|
Service Code
|
MS-DRG 604
|
| Min. Negotiated Rate |
$10,773.06 |
| Max. Negotiated Rate |
$22,975.57 |
| Rate for Payer: Aetna Medicare |
$11,793.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,175.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,175.08
|
| Rate for Payer: BCBS MAPPO |
$11,340.06
|
| Rate for Payer: BCBS Trust/PPO |
$14,453.41
|
| Rate for Payer: BCN Medicare Advantage |
$11,340.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,340.06
|
| Rate for Payer: Mclaren Medicare |
$11,340.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,907.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,041.07
|
| Rate for Payer: PACE Medicare |
$10,773.06
|
| Rate for Payer: PACE SWMI |
$11,340.06
|
| Rate for Payer: PHP Medicare Advantage |
$11,340.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,613.85
|
| Rate for Payer: Priority Health Medicare |
$11,340.06
|
| Rate for Payer: Priority Health Narrow Network |
$17,291.08
|
| Rate for Payer: Railroad Medicare Medicare |
$11,340.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,975.57
|
| Rate for Payer: UHC Core |
$14,098.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,340.06
|
| Rate for Payer: UHC Exchange |
$15,099.66
|
| Rate for Payer: UHC Medicare Advantage |
$11,680.26
|
| Rate for Payer: VA VA |
$11,340.06
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC
|
Facility
IP
|
$13,862.84
|
|
|
Service Code
|
MS-DRG 605
|
| Min. Negotiated Rate |
$6,685.83 |
| Max. Negotiated Rate |
$13,862.84 |
| Rate for Payer: Aetna Medicare |
$7,319.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,797.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,797.15
|
| Rate for Payer: BCBS MAPPO |
$7,037.72
|
| Rate for Payer: BCBS Trust/PPO |
$12,448.56
|
| Rate for Payer: BCN Medicare Advantage |
$7,037.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,037.72
|
| Rate for Payer: Mclaren Medicare |
$7,037.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,389.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,093.38
|
| Rate for Payer: PACE Medicare |
$6,685.83
|
| Rate for Payer: PACE SWMI |
$7,037.72
|
| Rate for Payer: PHP Medicare Advantage |
$7,037.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,041.21
|
| Rate for Payer: Priority Health Medicare |
$7,037.72
|
| Rate for Payer: Priority Health Narrow Network |
$10,432.97
|
| Rate for Payer: Railroad Medicare Medicare |
$7,037.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,862.84
|
| Rate for Payer: UHC Core |
$8,506.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,037.72
|
| Rate for Payer: UHC Exchange |
$9,110.72
|
| Rate for Payer: UHC Medicare Advantage |
$7,248.85
|
| Rate for Payer: VA VA |
$7,037.72
|
|
|
TRAZODONE 100 MG TABLET
|
Facility
IP
|
$333.70
|
|
|
Service Code
|
NDC 0904-6869-61
|
| Hospital Charge Code |
8083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.23 |
| Max. Negotiated Rate |
$300.33 |
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.90
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$233.59
|
| Rate for Payer: Cofinity Commercial |
$286.98
|
| Rate for Payer: Healthscope Commercial |
$300.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.64
|
| Rate for Payer: PHP Commercial |
$283.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.59
|
| Rate for Payer: Priority Health SBD |
$210.23
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
IP
|
$350.15
|
|
|
Service Code
|
NDC 50111-450-01
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.59 |
| Max. Negotiated Rate |
$315.14 |
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.60
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Healthscope Commercial |
$315.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.63
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.10
|
| Rate for Payer: Priority Health SBD |
$220.59
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
IP
|
$3.55
|
|
|
Service Code
|
NDC 68084-608-11
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.31
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.02
|
| Rate for Payer: PHP Commercial |
$3.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.48
|
| Rate for Payer: Priority Health SBD |
$2.24
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
IP
|
$4.43
|
|
|
Service Code
|
NDC 60687-432-11
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$3.99 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.88
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.81
|
| Rate for Payer: Healthscope Commercial |
$3.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.77
|
| Rate for Payer: PHP Commercial |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.10
|
| Rate for Payer: Priority Health SBD |
$2.79
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
IP
|
$354.35
|
|
|
Service Code
|
NDC 68084-608-01
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.24 |
| Max. Negotiated Rate |
$318.92 |
| Rate for Payer: Aetna Commercial |
$301.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.33
|
| Rate for Payer: Cash Price |
$283.48
|
| Rate for Payer: Cofinity Commercial |
$248.04
|
| Rate for Payer: Cofinity Commercial |
$304.74
|
| Rate for Payer: Healthscope Commercial |
$318.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$301.20
|
| Rate for Payer: PHP Commercial |
$301.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.04
|
| Rate for Payer: Priority Health SBD |
$223.24
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
IP
|
$442.70
|
|
|
Service Code
|
NDC 60687-432-01
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.90 |
| Max. Negotiated Rate |
$398.43 |
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.76
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$380.72
|
| Rate for Payer: Cofinity Commercial |
$309.89
|
| Rate for Payer: Healthscope Commercial |
$398.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.30
|
| Rate for Payer: PHP Commercial |
$376.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.89
|
| Rate for Payer: Priority Health SBD |
$278.90
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
IP
|
$2.61
|
|
|
Service Code
|
NDC 60687-443-11
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.70
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$1.83
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Healthscope Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.22
|
| Rate for Payer: PHP Commercial |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.83
|
| Rate for Payer: Priority Health SBD |
$1.64
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
IP
|
$260.85
|
|
|
Service Code
|
NDC 60687-443-01
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.34 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.55
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$182.60
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.72
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.60
|
| Rate for Payer: Priority Health SBD |
$164.34
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
IP
|
$242.05
|
|
|
Service Code
|
NDC 0904-6868-61
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.49 |
| Max. Negotiated Rate |
$217.84 |
| Rate for Payer: Aetna Commercial |
$205.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.33
|
| Rate for Payer: Cash Price |
$193.64
|
| Rate for Payer: Cofinity Commercial |
$169.44
|
| Rate for Payer: Cofinity Commercial |
$208.16
|
| Rate for Payer: Healthscope Commercial |
$217.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.74
|
| Rate for Payer: PHP Commercial |
$205.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.44
|
| Rate for Payer: Priority Health SBD |
$152.49
|
|
|
TREATMENT OF HUMERAL SHAFT FRACTURE, WITH INSERTION OF INTRAMEDULLARY IMPLANT, WITH OR WITHOUT CERCLAGE AND/OR LOCKING SCREWS
|
Facility
OP
|
$39,125.19
|
|
|
Service Code
|
CPT 24516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$852.33 |
| Max. Negotiated Rate |
$39,125.19 |
| Rate for Payer: Aetna Medicare |
$12,179.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,638.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,638.36
|
| Rate for Payer: BCBS Complete |
$6,726.62
|
| Rate for Payer: BCBS MAPPO |
$11,710.69
|
| Rate for Payer: BCBS Trust/PPO |
$4,321.68
|
| Rate for Payer: BCN Medicare Advantage |
$11,710.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,710.69
|
| Rate for Payer: Mclaren Medicaid |
$6,405.75
|
| Rate for Payer: Mclaren Medicare |
$11,710.69
|
| Rate for Payer: Meridian Medicaid |
$6,726.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,296.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,467.29
|
| Rate for Payer: PACE Medicare |
$11,125.16
|
| Rate for Payer: PACE SWMI |
$11,710.69
|
| Rate for Payer: PHP Medicare Advantage |
$11,710.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,405.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39,125.19
|
| Rate for Payer: Priority Health Medicare |
$11,710.69
|
| Rate for Payer: Priority Health Narrow Network |
$31,300.15
|
| Rate for Payer: Railroad Medicare Medicare |
$11,710.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$937.56
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,710.69
|
| Rate for Payer: UHC Exchange |
$852.33
|
| Rate for Payer: UHC Medicare Advantage |
$12,062.01
|
| Rate for Payer: VA VA |
$11,710.69
|
|
|
TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETED SURGICALLY
|
Facility
OP
|
$8,478.18
|
|
|
Service Code
|
CPT 59812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$8,478.18 |
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,417.50
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,478.18
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Priority Health Narrow Network |
$6,782.54
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.78
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$306.16
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
TREATMENT OF INTERTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTURE; WITH INTRAMEDULLARY IMPLANT, WITH OR WITHOUT INTERLOCKING SCREWS AND/OR CERCLAGE
|
Facility
OP
|
$6,837.00
|
|
|
Service Code
|
CPT 27245
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,209.90 |
| Max. Negotiated Rate |
$6,837.00 |
| Rate for Payer: BCBS Trust/PPO |
$2,499.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,330.89
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Exchange |
$1,209.90
|
|
|
TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER
|
Facility
OP
|
$8,478.18
|
|
|
Service Code
|
CPT 59820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$385.40 |
| Max. Negotiated Rate |
$8,478.18 |
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,299.88
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,478.18
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Priority Health Narrow Network |
$6,782.54
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.94
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$385.40
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE
|
Facility
OP
|
$1,757.43
|
|
|
Service Code
|
CPT 12020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$185.33 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna Medicare |
$581.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.54
|
| Rate for Payer: BCBS Complete |
$320.99
|
| Rate for Payer: BCBS MAPPO |
$558.83
|
| Rate for Payer: BCBS Trust/PPO |
$363.15
|
| Rate for Payer: BCN Medicare Advantage |
$558.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.83
|
| Rate for Payer: Mclaren Medicaid |
$305.68
|
| Rate for Payer: Mclaren Medicare |
$558.83
|
| Rate for Payer: Meridian Medicaid |
$320.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.65
|
| Rate for Payer: PACE Medicare |
$530.89
|
| Rate for Payer: PACE SWMI |
$558.83
|
| Rate for Payer: PHP Medicare Advantage |
$558.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Railroad Medicare Medicare |
$558.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.86
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.83
|
| Rate for Payer: UHC Exchange |
$185.33
|
| Rate for Payer: UHC Medicare Advantage |
$575.59
|
| Rate for Payer: VA VA |
$558.83
|
|
|
TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE
|
Facility
OP
|
$1,757.43
|
|
|
Service Code
|
CPT 12020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$185.33 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna Medicare |
$581.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.54
|
| Rate for Payer: BCBS Complete |
$320.99
|
| Rate for Payer: BCBS MAPPO |
$558.83
|
| Rate for Payer: BCBS Trust/PPO |
$363.15
|
| Rate for Payer: BCN Medicare Advantage |
$558.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.83
|
| Rate for Payer: Mclaren Medicaid |
$305.68
|
| Rate for Payer: Mclaren Medicare |
$558.83
|
| Rate for Payer: Meridian Medicaid |
$320.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.65
|
| Rate for Payer: PACE Medicare |
$530.89
|
| Rate for Payer: PACE SWMI |
$558.83
|
| Rate for Payer: PHP Medicare Advantage |
$558.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Railroad Medicare Medicare |
$558.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.86
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.83
|
| Rate for Payer: UHC Exchange |
$185.33
|
| Rate for Payer: UHC Medicare Advantage |
$575.59
|
| Rate for Payer: VA VA |
$558.83
|
|
|
TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE) BY INTRAMEDULLARY IMPLANT, WITH OR WITHOUT INTERLOCKING SCREWS AND/OR CERCLAGE
|
Facility
OP
|
$38,393.11
|
|
|
Service Code
|
CPT 27759
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$986.58 |
| Max. Negotiated Rate |
$38,393.11 |
| Rate for Payer: Aetna Medicare |
$12,179.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,638.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,638.36
|
| Rate for Payer: BCBS Complete |
$6,726.62
|
| Rate for Payer: BCBS MAPPO |
$11,710.69
|
| Rate for Payer: BCBS Trust/PPO |
$4,383.67
|
| Rate for Payer: BCN Medicare Advantage |
$11,710.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,710.69
|
| Rate for Payer: Mclaren Medicaid |
$6,405.75
|
| Rate for Payer: Mclaren Medicare |
$11,710.69
|
| Rate for Payer: Meridian Medicaid |
$6,726.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,296.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,467.29
|
| Rate for Payer: PACE Medicare |
$11,125.16
|
| Rate for Payer: PACE SWMI |
$11,710.69
|
| Rate for Payer: PHP Medicare Advantage |
$11,710.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,405.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,393.11
|
| Rate for Payer: Priority Health Medicare |
$11,710.69
|
| Rate for Payer: Priority Health Narrow Network |
$30,714.49
|
| Rate for Payer: Railroad Medicare Medicare |
$11,710.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,085.24
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,710.69
|
| Rate for Payer: UHC Exchange |
$986.58
|
| Rate for Payer: UHC Medicare Advantage |
$12,062.01
|
| Rate for Payer: VA VA |
$11,710.69
|
|
|
TRIAMCINOLONE ACETONIDE 0.147 MG/GRAM TOPICAL AEROSOL
|
Facility
IP
|
$1,735.12
|
|
|
Service Code
|
NDC 10631-093-62
|
| Hospital Charge Code |
19770
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,093.13 |
| Max. Negotiated Rate |
$1,561.61 |
| Rate for Payer: Aetna Commercial |
$1,474.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,127.83
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cofinity Commercial |
$1,214.58
|
| Rate for Payer: Cofinity Commercial |
$1,492.20
|
| Rate for Payer: Healthscope Commercial |
$1,561.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,474.85
|
| Rate for Payer: PHP Commercial |
$1,474.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,214.58
|
| Rate for Payer: Priority Health SBD |
$1,093.13
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
IP
|
$10.08
|
|
|
Service Code
|
NDC 67877-251-15
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$9.07 |
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.55
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cofinity Commercial |
$7.06
|
| Rate for Payer: Cofinity Commercial |
$8.67
|
| Rate for Payer: Healthscope Commercial |
$9.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.57
|
| Rate for Payer: PHP Commercial |
$8.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.06
|
| Rate for Payer: Priority Health SBD |
$6.35
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
IP
|
$12.63
|
|
|
Service Code
|
NDC 52565-056-15
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$11.37 |
| Rate for Payer: Aetna Commercial |
$10.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.21
|
| Rate for Payer: Cash Price |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$10.86
|
| Rate for Payer: Cofinity Commercial |
$8.84
|
| Rate for Payer: Healthscope Commercial |
$11.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.74
|
| Rate for Payer: PHP Commercial |
$10.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.84
|
| Rate for Payer: Priority Health SBD |
$7.96
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
IP
|
$19.44
|
|
|
Service Code
|
NDC 0168-0006-15
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna Commercial |
$16.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.64
|
| Rate for Payer: Cash Price |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$13.61
|
| Rate for Payer: Cofinity Commercial |
$16.72
|
| Rate for Payer: Healthscope Commercial |
$17.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.52
|
| Rate for Payer: PHP Commercial |
$16.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.61
|
| Rate for Payer: Priority Health SBD |
$12.25
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
IP
|
$17.96
|
|
|
Service Code
|
NDC 51672-1284-1
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna Commercial |
$15.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.67
|
| Rate for Payer: Cash Price |
$14.37
|
| Rate for Payer: Cofinity Commercial |
$12.57
|
| Rate for Payer: Cofinity Commercial |
$15.45
|
| Rate for Payer: Healthscope Commercial |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.27
|
| Rate for Payer: PHP Commercial |
$15.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.57
|
| Rate for Payer: Priority Health SBD |
$11.31
|
|
