|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
IP
|
$26.83
|
|
|
Service Code
|
NDC 0409-4887-50
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.44
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Commercial |
$18.78
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Healthscope Commercial |
$24.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.81
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.78
|
| Rate for Payer: Priority Health SBD |
$16.90
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
OP
|
$27.38
|
|
|
Service Code
|
NDC 0409-4887-25
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.80
|
| Rate for Payer: BCBS Complete |
$10.95
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$19.17
|
| Rate for Payer: Cofinity Commercial |
$23.55
|
| Rate for Payer: Healthscope Commercial |
$24.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.27
|
| Rate for Payer: PHP Commercial |
$23.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.17
|
| Rate for Payer: Priority Health SBD |
$17.25
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
IP
|
$27.38
|
|
|
Service Code
|
NDC 0409-4887-25
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.80
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$19.17
|
| Rate for Payer: Cofinity Commercial |
$23.55
|
| Rate for Payer: Healthscope Commercial |
$24.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.27
|
| Rate for Payer: PHP Commercial |
$23.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.17
|
| Rate for Payer: Priority Health SBD |
$17.25
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
IP
|
$13.75
|
|
|
Service Code
|
NDC 0409-4887-10
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.94
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Cofinity Commercial |
$9.62
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.69
|
| Rate for Payer: PHP Commercial |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health SBD |
$8.66
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
OP
|
$13.75
|
|
|
Service Code
|
NDC 0409-4887-10
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.94
|
| Rate for Payer: BCBS Complete |
$5.50
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Cofinity Commercial |
$9.62
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.69
|
| Rate for Payer: PHP Commercial |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health SBD |
$8.66
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
IP
|
$26.83
|
|
|
Service Code
|
NDC 0409-4887-24
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.44
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Commercial |
$18.78
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Healthscope Commercial |
$24.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.81
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.78
|
| Rate for Payer: Priority Health SBD |
$16.90
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
IP
|
$14.79
|
|
|
Service Code
|
NDC 0409-4887-20
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$13.31 |
| Rate for Payer: Aetna Commercial |
$12.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.61
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cofinity Commercial |
$10.35
|
| Rate for Payer: Cofinity Commercial |
$12.72
|
| Rate for Payer: Healthscope Commercial |
$13.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.57
|
| Rate for Payer: PHP Commercial |
$12.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.35
|
| Rate for Payer: Priority Health SBD |
$9.32
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
IP
|
$14.79
|
|
|
Service Code
|
NDC 0409-4887-23
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$13.31 |
| Rate for Payer: Aetna Commercial |
$12.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.61
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cofinity Commercial |
$10.35
|
| Rate for Payer: Cofinity Commercial |
$12.72
|
| Rate for Payer: Healthscope Commercial |
$13.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.57
|
| Rate for Payer: PHP Commercial |
$12.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.35
|
| Rate for Payer: Priority Health SBD |
$9.32
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
OP
|
$27.38
|
|
|
Service Code
|
NDC 0409-4887-99
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.80
|
| Rate for Payer: BCBS Complete |
$10.95
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$19.17
|
| Rate for Payer: Cofinity Commercial |
$23.55
|
| Rate for Payer: Healthscope Commercial |
$24.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.27
|
| Rate for Payer: PHP Commercial |
$23.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.17
|
| Rate for Payer: Priority Health SBD |
$17.25
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
IP
|
$13.75
|
|
|
Service Code
|
NDC 0409-4887-17
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.94
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Cofinity Commercial |
$9.62
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.69
|
| Rate for Payer: PHP Commercial |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health SBD |
$8.66
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION
|
Facility
OP
|
$13.75
|
|
|
Service Code
|
NDC 0409-4887-17
|
| Hospital Charge Code |
11671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$12.38 |
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.94
|
| Rate for Payer: BCBS Complete |
$5.50
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Cofinity Commercial |
$9.62
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.69
|
| Rate for Payer: PHP Commercial |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health SBD |
$8.66
|
|
|
WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION
|
Facility
IP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0013-04
|
| Hospital Charge Code |
28400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.15 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.67
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.50
|
| Rate for Payer: Priority Health SBD |
$30.15
|
|
|
WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION
|
Facility
OP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0013-04
|
| Hospital Charge Code |
28400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.67
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.50
|
| Rate for Payer: Priority Health SBD |
$30.15
|
|
|
WATER FOR IRRIGATION, STERILE SOLUTION
|
Facility
IP
|
$69.92
|
|
|
Service Code
|
NDC 0338-0004-04
|
| Hospital Charge Code |
7485
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.05 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.94
|
| Rate for Payer: Priority Health SBD |
$44.05
|
|
|
WATER FOR IRRIGATION, STERILE SOLUTION
|
Facility
IP
|
$63.80
|
|
|
Service Code
|
NDC 0338-0004-03
|
| Hospital Charge Code |
7485
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.19 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.23
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.66
|
| Rate for Payer: Priority Health SBD |
$40.19
|
|
|
WATER FOR IRRIGATION, STERILE SOLUTION
|
Facility
IP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0004-05
|
| Hospital Charge Code |
7485
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.15 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.67
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.50
|
| Rate for Payer: Priority Health SBD |
$30.15
|
|
|
WATER FOR IRRIGATION, STERILE SOLUTION
|
Facility
IP
|
$95.70
|
|
|
Service Code
|
NDC 0338-0003-47
|
| Hospital Charge Code |
7485
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.29 |
| Max. Negotiated Rate |
$86.13 |
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.20
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cofinity Commercial |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$82.30
|
| Rate for Payer: Healthscope Commercial |
$86.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.34
|
| Rate for Payer: PHP Commercial |
$81.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.99
|
| Rate for Payer: Priority Health SBD |
$60.29
|
|
|
WHITE PETROLATUM 43 % TOPICAL OINTMENT
|
Facility
IP
|
$14.87
|
|
|
Service Code
|
NDC 53329-773-14
|
| Hospital Charge Code |
118982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$13.38 |
| Rate for Payer: Aetna Commercial |
$12.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.67
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Cofinity Commercial |
$12.79
|
| Rate for Payer: Healthscope Commercial |
$13.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.64
|
| Rate for Payer: PHP Commercial |
$12.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.41
|
| Rate for Payer: Priority Health SBD |
$9.37
|
|
|
WHITE PETROLATUM 43 % TOPICAL OINTMENT
|
Facility
IP
|
$31.64
|
|
|
Service Code
|
NDC 53329-077-31
|
| Hospital Charge Code |
118982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.93 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: Aetna Commercial |
$26.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.57
|
| Rate for Payer: Cash Price |
$25.31
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Cofinity Commercial |
$27.21
|
| Rate for Payer: Healthscope Commercial |
$28.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.89
|
| Rate for Payer: PHP Commercial |
$26.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.15
|
| Rate for Payer: Priority Health SBD |
$19.93
|
|
|
WHITE PETROLATUM 57.7 %-MINERAL OIL 31.9 % EYE OINTMENT
|
Facility
IP
|
$24.64
|
|
|
Service Code
|
NDC 6373614308
|
| Hospital Charge Code |
175688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$20.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.02
|
| Rate for Payer: Cash Price |
$19.71
|
| Rate for Payer: Cofinity Commercial |
$17.25
|
| Rate for Payer: Cofinity Commercial |
$21.19
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.94
|
| Rate for Payer: PHP Commercial |
$20.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.25
|
| Rate for Payer: Priority Health SBD |
$15.52
|
|
|
WHITE PETROLATUM EYE OINTMENT WRAPPER
|
Facility
IP
|
$24.64
|
|
|
Service Code
|
NDC 6373614308
|
| Hospital Charge Code |
301577
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$20.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.02
|
| Rate for Payer: Cash Price |
$19.71
|
| Rate for Payer: Cofinity Commercial |
$17.25
|
| Rate for Payer: Cofinity Commercial |
$21.19
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.94
|
| Rate for Payer: PHP Commercial |
$20.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.25
|
| Rate for Payer: Priority Health SBD |
$15.52
|
|
|
WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM
|
Facility
IP
|
$12.88
|
|
|
Service Code
|
NDC 6192417804
|
| Hospital Charge Code |
11371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$11.59 |
| Rate for Payer: Aetna Commercial |
$10.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.37
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cofinity Commercial |
$11.08
|
| Rate for Payer: Cofinity Commercial |
$9.02
|
| Rate for Payer: Healthscope Commercial |
$11.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.95
|
| Rate for Payer: PHP Commercial |
$10.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.02
|
| Rate for Payer: Priority Health SBD |
$8.11
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
IP
|
$52,332.69
|
|
|
Service Code
|
MS-DRG 464
|
| Min. Negotiated Rate |
$21,002.78 |
| Max. Negotiated Rate |
$52,332.69 |
| Rate for Payer: Aetna Medicare |
$22,992.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,635.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,635.24
|
| Rate for Payer: BCBS MAPPO |
$22,108.19
|
| Rate for Payer: BCBS Trust/PPO |
$52,332.69
|
| Rate for Payer: BCN Medicare Advantage |
$22,108.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,108.19
|
| Rate for Payer: Mclaren Medicare |
$22,108.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23,213.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,424.42
|
| Rate for Payer: PACE Medicare |
$21,002.78
|
| Rate for Payer: PACE SWMI |
$22,108.19
|
| Rate for Payer: PHP Medicare Advantage |
$22,108.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43,069.85
|
| Rate for Payer: Priority Health Medicare |
$22,108.19
|
| Rate for Payer: Priority Health Narrow Network |
$34,455.88
|
| Rate for Payer: Railroad Medicare Medicare |
$22,108.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45,783.36
|
| Rate for Payer: UHC Core |
$28,093.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$22,108.19
|
| Rate for Payer: UHC Exchange |
$30,089.04
|
| Rate for Payer: UHC Medicare Advantage |
$22,771.44
|
| Rate for Payer: VA VA |
$22,108.19
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
IP
|
$95,482.12
|
|
|
Service Code
|
MS-DRG 463
|
| Min. Negotiated Rate |
$39,217.45 |
| Max. Negotiated Rate |
$95,482.12 |
| Rate for Payer: Aetna Medicare |
$42,932.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51,601.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51,601.91
|
| Rate for Payer: BCBS MAPPO |
$41,281.53
|
| Rate for Payer: BCBS Trust/PPO |
$95,482.12
|
| Rate for Payer: BCN Medicare Advantage |
$41,281.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41,281.53
|
| Rate for Payer: Mclaren Medicare |
$41,281.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43,345.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47,473.76
|
| Rate for Payer: PACE Medicare |
$39,217.45
|
| Rate for Payer: PACE SWMI |
$41,281.53
|
| Rate for Payer: PHP Medicare Advantage |
$41,281.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81,273.64
|
| Rate for Payer: Priority Health Medicare |
$41,281.53
|
| Rate for Payer: Priority Health Narrow Network |
$65,018.91
|
| Rate for Payer: Railroad Medicare Medicare |
$41,281.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86,394.08
|
| Rate for Payer: UHC Core |
$53,012.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$41,281.53
|
| Rate for Payer: UHC Exchange |
$56,778.59
|
| Rate for Payer: UHC Medicare Advantage |
$42,519.98
|
| Rate for Payer: VA VA |
$41,281.53
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$29,761.03
|
|
|
Service Code
|
MS-DRG 465
|
| Min. Negotiated Rate |
$13,267.55 |
| Max. Negotiated Rate |
$29,761.03 |
| Rate for Payer: Aetna Medicare |
$14,524.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,457.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,457.30
|
| Rate for Payer: BCBS MAPPO |
$13,965.84
|
| Rate for Payer: BCBS Trust/PPO |
$29,761.03
|
| Rate for Payer: BCN Medicare Advantage |
$13,965.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,965.84
|
| Rate for Payer: Mclaren Medicare |
$13,965.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,664.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,060.72
|
| Rate for Payer: PACE Medicare |
$13,267.55
|
| Rate for Payer: PACE SWMI |
$13,965.84
|
| Rate for Payer: PHP Medicare Advantage |
$13,965.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,845.83
|
| Rate for Payer: Priority Health Medicare |
$13,965.84
|
| Rate for Payer: Priority Health Narrow Network |
$21,476.66
|
| Rate for Payer: Railroad Medicare Medicare |
$13,965.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,537.18
|
| Rate for Payer: UHC Core |
$17,510.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,965.84
|
| Rate for Payer: UHC Exchange |
$18,754.77
|
| Rate for Payer: UHC Medicare Advantage |
$14,384.82
|
| Rate for Payer: VA VA |
$13,965.84
|
|
