|
TRANSURETHRAL RESECTION; RESIDUAL OR REGROWTH OF OBSTRUCTIVE PROSTATE TISSUE INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)
|
Facility
|
OP
|
$13,737.10
|
|
|
Service Code
|
CPT 52630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$399.48 |
| Max. Negotiated Rate |
$13,737.10 |
| Rate for Payer: Aetna Medicare |
$4,788.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,755.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,755.12
|
| Rate for Payer: BCBS Complete |
$2,644.60
|
| Rate for Payer: BCBS MAPPO |
$4,604.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,387.17
|
| Rate for Payer: BCN Medicare Advantage |
$4,604.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,604.10
|
| Rate for Payer: Mclaren Medicaid |
$2,518.44
|
| Rate for Payer: Mclaren Medicare |
$4,604.10
|
| Rate for Payer: Meridian Medicaid |
$2,644.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,834.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,294.72
|
| Rate for Payer: PACE Medicare |
$4,373.90
|
| Rate for Payer: PACE SWMI |
$4,604.10
|
| Rate for Payer: PHP Medicare Advantage |
$4,604.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,518.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,737.10
|
| Rate for Payer: Priority Health Medicare |
$4,604.10
|
| Rate for Payer: Priority Health Narrow Network |
$10,989.68
|
| Rate for Payer: Railroad Medicare Medicare |
$4,604.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$439.43
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,604.10
|
| Rate for Payer: UHC Exchange |
$399.48
|
| Rate for Payer: UHC Medicare Advantage |
$4,742.22
|
| Rate for Payer: VA VA |
$4,604.10
|
|
|
TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BLOCK) BILATERAL; BY INJECTIONS (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED)
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 64488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$66.47 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: BCBS Trust/PPO |
$812.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.12
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$66.47
|
|
|
TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,947.73
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
183257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.01 |
| Max. Negotiated Rate |
$5,352.96 |
| Rate for Payer: Aetna Commercial |
$5,055.57
|
| Rate for Payer: Aetna Medicare |
$83.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,866.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.58
|
| Rate for Payer: BCBS Complete |
$46.22
|
| Rate for Payer: BCBS MAPPO |
$80.46
|
| Rate for Payer: BCBS Trust/PPO |
$238.21
|
| Rate for Payer: BCN Medicare Advantage |
$80.46
|
| Rate for Payer: Cash Price |
$4,758.18
|
| Rate for Payer: Cash Price |
$4,758.18
|
| Rate for Payer: Cofinity Commercial |
$4,163.41
|
| Rate for Payer: Cofinity Commercial |
$5,115.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.46
|
| Rate for Payer: Healthscope Commercial |
$5,352.96
|
| Rate for Payer: Mclaren Medicaid |
$44.01
|
| Rate for Payer: Mclaren Medicare |
$80.46
|
| Rate for Payer: Meridian Medicaid |
$46.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,055.57
|
| Rate for Payer: PACE Medicare |
$76.44
|
| Rate for Payer: PACE SWMI |
$80.46
|
| Rate for Payer: PHP Commercial |
$5,055.57
|
| Rate for Payer: PHP Medicare Advantage |
$80.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,163.41
|
| Rate for Payer: Priority Health Medicare |
$80.46
|
| Rate for Payer: Priority Health SBD |
$3,747.07
|
| Rate for Payer: Railroad Medicare Medicare |
$80.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.46
|
| Rate for Payer: UHC Medicare Advantage |
$82.88
|
| Rate for Payer: VA VA |
$80.46
|
|
|
TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15,583.81
|
|
|
Service Code
|
HCPCS Q5117
|
| Hospital Charge Code |
190713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$14,025.43 |
| Rate for Payer: Aetna Commercial |
$13,246.24
|
| Rate for Payer: Aetna Medicare |
$13.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,129.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.70
|
| Rate for Payer: BCBS Complete |
$7.21
|
| Rate for Payer: BCBS MAPPO |
$12.56
|
| Rate for Payer: BCBS Trust/PPO |
$23.13
|
| Rate for Payer: BCN Medicare Advantage |
$12.56
|
| Rate for Payer: Cash Price |
$12,467.05
|
| Rate for Payer: Cash Price |
$12,467.05
|
| Rate for Payer: Cofinity Commercial |
$10,908.67
|
| Rate for Payer: Cofinity Commercial |
$13,402.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.56
|
| Rate for Payer: Healthscope Commercial |
$14,025.43
|
| Rate for Payer: Mclaren Medicaid |
$6.87
|
| Rate for Payer: Mclaren Medicare |
$12.56
|
| Rate for Payer: Meridian Medicaid |
$7.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,246.24
|
| Rate for Payer: PACE Medicare |
$11.93
|
| Rate for Payer: PACE SWMI |
$12.56
|
| Rate for Payer: PHP Commercial |
$13,246.24
|
| Rate for Payer: PHP Medicare Advantage |
$12.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,908.67
|
| Rate for Payer: Priority Health Medicare |
$12.56
|
| Rate for Payer: Priority Health SBD |
$9,817.80
|
| Rate for Payer: Railroad Medicare Medicare |
$12.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.56
|
| Rate for Payer: UHC Medicare Advantage |
$12.94
|
| Rate for Payer: VA VA |
$12.56
|
|
|
TRASTUZUMAB-PKRB 150 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,139.81
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
193057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$5,525.83 |
| Rate for Payer: Aetna Commercial |
$5,218.84
|
| Rate for Payer: Aetna Medicare |
$41.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,990.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.38
|
| Rate for Payer: BCBS Complete |
$23.15
|
| Rate for Payer: BCBS MAPPO |
$40.31
|
| Rate for Payer: BCBS Trust/PPO |
$107.42
|
| Rate for Payer: BCN Medicare Advantage |
$40.31
|
| Rate for Payer: Cash Price |
$4,911.85
|
| Rate for Payer: Cash Price |
$4,911.85
|
| Rate for Payer: Cofinity Commercial |
$5,280.24
|
| Rate for Payer: Cofinity Commercial |
$4,297.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.31
|
| Rate for Payer: Healthscope Commercial |
$5,525.83
|
| Rate for Payer: Mclaren Medicaid |
$22.05
|
| Rate for Payer: Mclaren Medicare |
$40.31
|
| Rate for Payer: Meridian Medicaid |
$23.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,218.84
|
| Rate for Payer: PACE Medicare |
$38.29
|
| Rate for Payer: PACE SWMI |
$40.31
|
| Rate for Payer: PHP Commercial |
$5,218.84
|
| Rate for Payer: PHP Medicare Advantage |
$40.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,297.87
|
| Rate for Payer: Priority Health Medicare |
$40.31
|
| Rate for Payer: Priority Health SBD |
$3,868.08
|
| Rate for Payer: Railroad Medicare Medicare |
$40.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.31
|
| Rate for Payer: UHC Medicare Advantage |
$41.52
|
| Rate for Payer: VA VA |
$40.31
|
|
|
TRASTUZUMAB-PKRB 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17,191.45
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
192874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$15,472.30 |
| Rate for Payer: Aetna Commercial |
$14,612.73
|
| Rate for Payer: Aetna Medicare |
$41.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,174.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.38
|
| Rate for Payer: BCBS Complete |
$23.15
|
| Rate for Payer: BCBS MAPPO |
$40.31
|
| Rate for Payer: BCBS Trust/PPO |
$107.42
|
| Rate for Payer: BCN Medicare Advantage |
$40.31
|
| Rate for Payer: Cash Price |
$13,753.16
|
| Rate for Payer: Cash Price |
$13,753.16
|
| Rate for Payer: Cofinity Commercial |
$14,784.65
|
| Rate for Payer: Cofinity Commercial |
$12,034.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.31
|
| Rate for Payer: Healthscope Commercial |
$15,472.30
|
| Rate for Payer: Mclaren Medicaid |
$22.05
|
| Rate for Payer: Mclaren Medicare |
$40.31
|
| Rate for Payer: Meridian Medicaid |
$23.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,612.73
|
| Rate for Payer: PACE Medicare |
$38.29
|
| Rate for Payer: PACE SWMI |
$40.31
|
| Rate for Payer: PHP Commercial |
$14,612.73
|
| Rate for Payer: PHP Medicare Advantage |
$40.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,034.02
|
| Rate for Payer: Priority Health Medicare |
$40.31
|
| Rate for Payer: Priority Health SBD |
$10,830.61
|
| Rate for Payer: Railroad Medicare Medicare |
$40.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.31
|
| Rate for Payer: UHC Medicare Advantage |
$41.52
|
| Rate for Payer: VA VA |
$40.31
|
|
|
TRASTUZUMAB-PKRB 420 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17,191.45
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
192874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,830.61 |
| Max. Negotiated Rate |
$15,472.30 |
| Rate for Payer: Aetna Commercial |
$14,612.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,174.44
|
| Rate for Payer: Cash Price |
$13,753.16
|
| Rate for Payer: Cofinity Commercial |
$12,034.02
|
| Rate for Payer: Cofinity Commercial |
$14,784.65
|
| Rate for Payer: Healthscope Commercial |
$15,472.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,612.73
|
| Rate for Payer: PHP Commercial |
$14,612.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,034.02
|
| Rate for Payer: Priority Health SBD |
$10,830.61
|
|
|
TRASTUZUMAB-QYYP 150 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,923.37
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
196476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,471.72 |
| Max. Negotiated Rate |
$3,531.03 |
| Rate for Payer: Aetna Commercial |
$3,334.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,550.19
|
| Rate for Payer: Cash Price |
$3,138.70
|
| Rate for Payer: Cofinity Commercial |
$2,746.36
|
| Rate for Payer: Cofinity Commercial |
$3,374.10
|
| Rate for Payer: Healthscope Commercial |
$3,531.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,334.86
|
| Rate for Payer: PHP Commercial |
$3,334.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,746.36
|
| Rate for Payer: Priority Health SBD |
$2,471.72
|
|
|
TRASTUZUMAB-QYYP 150 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,923.37
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
196476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$3,531.03 |
| Rate for Payer: Aetna Commercial |
$3,334.86
|
| Rate for Payer: Aetna Medicare |
$17.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,550.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.46
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: BCBS MAPPO |
$16.37
|
| Rate for Payer: BCBS Trust/PPO |
$32.28
|
| Rate for Payer: BCN Medicare Advantage |
$16.37
|
| Rate for Payer: Cash Price |
$3,138.70
|
| Rate for Payer: Cash Price |
$3,138.70
|
| Rate for Payer: Cofinity Commercial |
$3,374.10
|
| Rate for Payer: Cofinity Commercial |
$2,746.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.37
|
| Rate for Payer: Healthscope Commercial |
$3,531.03
|
| Rate for Payer: Mclaren Medicaid |
$8.95
|
| Rate for Payer: Mclaren Medicare |
$16.37
|
| Rate for Payer: Meridian Medicaid |
$9.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,334.86
|
| Rate for Payer: PACE Medicare |
$15.55
|
| Rate for Payer: PACE SWMI |
$16.37
|
| Rate for Payer: PHP Commercial |
$3,334.86
|
| Rate for Payer: PHP Medicare Advantage |
$16.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,746.36
|
| Rate for Payer: Priority Health Medicare |
$16.37
|
| Rate for Payer: Priority Health SBD |
$2,471.72
|
| Rate for Payer: Railroad Medicare Medicare |
$16.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.37
|
| Rate for Payer: UHC Medicare Advantage |
$16.86
|
| Rate for Payer: VA VA |
$16.37
|
|
|
TRASTUZUMAB-QYYP 420 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$10,985.55
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
192875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,920.90 |
| Max. Negotiated Rate |
$9,887.00 |
| Rate for Payer: Aetna Commercial |
$9,337.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,140.61
|
| Rate for Payer: Cash Price |
$8,788.44
|
| Rate for Payer: Cofinity Commercial |
$7,689.88
|
| Rate for Payer: Cofinity Commercial |
$9,447.57
|
| Rate for Payer: Healthscope Commercial |
$9,887.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,337.72
|
| Rate for Payer: PHP Commercial |
$9,337.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,689.88
|
| Rate for Payer: Priority Health SBD |
$6,920.90
|
|
|
TRASTUZUMAB-QYYP 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$10,985.55
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
192875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$9,887.00 |
| Rate for Payer: Aetna Commercial |
$9,337.72
|
| Rate for Payer: Aetna Medicare |
$17.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,140.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.46
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: BCBS MAPPO |
$16.37
|
| Rate for Payer: BCBS Trust/PPO |
$32.28
|
| Rate for Payer: BCN Medicare Advantage |
$16.37
|
| Rate for Payer: Cash Price |
$8,788.44
|
| Rate for Payer: Cash Price |
$8,788.44
|
| Rate for Payer: Cofinity Commercial |
$9,447.57
|
| Rate for Payer: Cofinity Commercial |
$7,689.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.37
|
| Rate for Payer: Healthscope Commercial |
$9,887.00
|
| Rate for Payer: Mclaren Medicaid |
$8.95
|
| Rate for Payer: Mclaren Medicare |
$16.37
|
| Rate for Payer: Meridian Medicaid |
$9.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,337.72
|
| Rate for Payer: PACE Medicare |
$15.55
|
| Rate for Payer: PACE SWMI |
$16.37
|
| Rate for Payer: PHP Commercial |
$9,337.72
|
| Rate for Payer: PHP Medicare Advantage |
$16.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,689.88
|
| Rate for Payer: Priority Health Medicare |
$16.37
|
| Rate for Payer: Priority Health SBD |
$6,920.90
|
| Rate for Payer: Railroad Medicare Medicare |
$16.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.37
|
| Rate for Payer: UHC Medicare Advantage |
$16.86
|
| Rate for Payer: VA VA |
$16.37
|
|
|
TRAUMATIC INJURY WITH MCC
|
Facility
|
IP
|
$22,797.10
|
|
|
Service Code
|
MS-DRG 913
|
| Min. Negotiated Rate |
$10,693.02 |
| Max. Negotiated Rate |
$22,797.10 |
| Rate for Payer: Aetna Medicare |
$11,706.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,069.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,069.76
|
| Rate for Payer: BCBS MAPPO |
$11,255.81
|
| Rate for Payer: BCBS Trust/PPO |
$19,482.02
|
| Rate for Payer: BCN Medicare Advantage |
$11,255.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,255.81
|
| Rate for Payer: Mclaren Medicare |
$11,255.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,818.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,944.18
|
| Rate for Payer: PACE Medicare |
$10,693.02
|
| Rate for Payer: PACE SWMI |
$11,255.81
|
| Rate for Payer: PHP Medicare Advantage |
$11,255.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,445.96
|
| Rate for Payer: Priority Health Medicare |
$11,255.81
|
| Rate for Payer: Priority Health Narrow Network |
$17,156.77
|
| Rate for Payer: Railroad Medicare Medicare |
$11,255.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,797.10
|
| Rate for Payer: UHC Core |
$13,988.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,255.81
|
| Rate for Payer: UHC Exchange |
$14,982.36
|
| Rate for Payer: UHC Medicare Advantage |
$11,593.48
|
| Rate for Payer: VA VA |
$11,255.81
|
|
|
TRAUMATIC INJURY WITHOUT MCC
|
Facility
|
IP
|
$15,533.80
|
|
|
Service Code
|
MS-DRG 914
|
| Min. Negotiated Rate |
$6,678.30 |
| Max. Negotiated Rate |
$15,533.80 |
| Rate for Payer: Aetna Medicare |
$7,310.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,787.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,787.24
|
| Rate for Payer: BCBS MAPPO |
$7,029.79
|
| Rate for Payer: BCBS Trust/PPO |
$15,533.80
|
| Rate for Payer: BCN Medicare Advantage |
$7,029.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,029.79
|
| Rate for Payer: Mclaren Medicare |
$7,029.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,381.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,084.26
|
| Rate for Payer: PACE Medicare |
$6,678.30
|
| Rate for Payer: PACE SWMI |
$7,029.79
|
| Rate for Payer: PHP Medicare Advantage |
$7,029.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,025.42
|
| Rate for Payer: Priority Health Medicare |
$7,029.79
|
| Rate for Payer: Priority Health Narrow Network |
$10,420.34
|
| Rate for Payer: Railroad Medicare Medicare |
$7,029.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,846.06
|
| Rate for Payer: UHC Core |
$8,496.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,029.79
|
| Rate for Payer: UHC Exchange |
$9,099.69
|
| Rate for Payer: UHC Medicare Advantage |
$7,240.68
|
| Rate for Payer: VA VA |
$7,029.79
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC
|
Facility
|
IP
|
$20,091.04
|
|
|
Service Code
|
MS-DRG 086
|
| Min. Negotiated Rate |
$9,479.29 |
| Max. Negotiated Rate |
$20,091.04 |
| Rate for Payer: Aetna Medicare |
$10,377.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,472.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,472.75
|
| Rate for Payer: BCBS MAPPO |
$9,978.20
|
| Rate for Payer: BCBS Trust/PPO |
$19,214.13
|
| Rate for Payer: BCN Medicare Advantage |
$9,978.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,978.20
|
| Rate for Payer: Mclaren Medicare |
$9,978.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,477.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,474.93
|
| Rate for Payer: PACE Medicare |
$9,479.29
|
| Rate for Payer: PACE SWMI |
$9,978.20
|
| Rate for Payer: PHP Medicare Advantage |
$9,978.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,900.28
|
| Rate for Payer: Priority Health Medicare |
$9,978.20
|
| Rate for Payer: Priority Health Narrow Network |
$15,120.22
|
| Rate for Payer: Railroad Medicare Medicare |
$9,978.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,091.04
|
| Rate for Payer: UHC Core |
$12,328.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,978.20
|
| Rate for Payer: UHC Exchange |
$13,203.93
|
| Rate for Payer: UHC Medicare Advantage |
$10,277.55
|
| Rate for Payer: VA VA |
$9,978.20
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC
|
Facility
|
IP
|
$23,768.42
|
|
|
Service Code
|
MS-DRG 083
|
| Min. Negotiated Rate |
$9,748.19 |
| Max. Negotiated Rate |
$23,768.42 |
| Rate for Payer: Aetna Medicare |
$10,671.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,826.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,826.56
|
| Rate for Payer: BCBS MAPPO |
$10,261.25
|
| Rate for Payer: BCBS Trust/PPO |
$23,768.42
|
| Rate for Payer: BCN Medicare Advantage |
$10,261.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,261.25
|
| Rate for Payer: Mclaren Medicare |
$10,261.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,774.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,800.44
|
| Rate for Payer: PACE Medicare |
$9,748.19
|
| Rate for Payer: PACE SWMI |
$10,261.25
|
| Rate for Payer: PHP Medicare Advantage |
$10,261.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,464.23
|
| Rate for Payer: Priority Health Medicare |
$10,261.25
|
| Rate for Payer: Priority Health Narrow Network |
$15,571.38
|
| Rate for Payer: Railroad Medicare Medicare |
$10,261.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,690.53
|
| Rate for Payer: UHC Core |
$12,695.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,261.25
|
| Rate for Payer: UHC Exchange |
$13,597.91
|
| Rate for Payer: UHC Medicare Advantage |
$10,569.09
|
| Rate for Payer: VA VA |
$10,261.25
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC
|
Facility
|
IP
|
$36,019.35
|
|
|
Service Code
|
MS-DRG 085
|
| Min. Negotiated Rate |
$16,017.91 |
| Max. Negotiated Rate |
$36,019.35 |
| Rate for Payer: Aetna Medicare |
$17,535.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,076.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,076.20
|
| Rate for Payer: BCBS MAPPO |
$16,860.96
|
| Rate for Payer: BCBS Trust/PPO |
$36,019.35
|
| Rate for Payer: BCN Medicare Advantage |
$16,860.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,860.96
|
| Rate for Payer: Mclaren Medicare |
$16,860.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,704.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,390.10
|
| Rate for Payer: PACE Medicare |
$16,017.91
|
| Rate for Payer: PACE SWMI |
$16,860.96
|
| Rate for Payer: PHP Medicare Advantage |
$16,860.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,614.50
|
| Rate for Payer: Priority Health Medicare |
$16,860.96
|
| Rate for Payer: Priority Health Narrow Network |
$26,091.60
|
| Rate for Payer: Railroad Medicare Medicare |
$16,860.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,669.29
|
| Rate for Payer: UHC Core |
$21,273.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,860.96
|
| Rate for Payer: UHC Exchange |
$22,784.82
|
| Rate for Payer: UHC Medicare Advantage |
$17,366.79
|
| Rate for Payer: VA VA |
$16,860.96
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC
|
Facility
|
IP
|
$43,887.26
|
|
|
Service Code
|
MS-DRG 082
|
| Min. Negotiated Rate |
$16,055.54 |
| Max. Negotiated Rate |
$43,887.26 |
| Rate for Payer: Aetna Medicare |
$17,576.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,125.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,125.71
|
| Rate for Payer: BCBS MAPPO |
$16,900.57
|
| Rate for Payer: BCBS Trust/PPO |
$43,887.26
|
| Rate for Payer: BCN Medicare Advantage |
$16,900.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,900.57
|
| Rate for Payer: Mclaren Medicare |
$16,900.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,745.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,435.66
|
| Rate for Payer: PACE Medicare |
$16,055.54
|
| Rate for Payer: PACE SWMI |
$16,900.57
|
| Rate for Payer: PHP Medicare Advantage |
$16,900.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,693.42
|
| Rate for Payer: Priority Health Medicare |
$16,900.57
|
| Rate for Payer: Priority Health Narrow Network |
$26,154.74
|
| Rate for Payer: Railroad Medicare Medicare |
$16,900.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,753.19
|
| Rate for Payer: UHC Core |
$21,324.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,900.57
|
| Rate for Payer: UHC Exchange |
$22,839.96
|
| Rate for Payer: UHC Medicare Advantage |
$17,407.59
|
| Rate for Payer: VA VA |
$16,900.57
|
|
|
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
|
$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 |
$309.89
|
| Rate for Payer: Cofinity Commercial |
$380.72
|
| 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 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
|
|
