|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$8,240.96
|
|
|
Service Code
|
APR-DRG 3142
|
| Min. Negotiated Rate |
$7,848.54 |
| Max. Negotiated Rate |
$8,240.96 |
| Rate for Payer: BCBS Complete |
$8,240.96
|
| Rate for Payer: Mclaren Medicaid |
$7,848.54
|
| Rate for Payer: Meridian Medicaid |
$8,240.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,848.54
|
| Rate for Payer: UHC Medicaid |
$7,848.54
|
| Rate for Payer: UHCCP Medicaid |
$7,848.54
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$5,812.11
|
|
|
Service Code
|
APR-DRG 3141
|
| Min. Negotiated Rate |
$5,535.34 |
| Max. Negotiated Rate |
$5,812.11 |
| Rate for Payer: BCBS Complete |
$5,812.11
|
| Rate for Payer: Mclaren Medicaid |
$5,535.34
|
| Rate for Payer: Meridian Medicaid |
$5,812.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,535.34
|
| Rate for Payer: UHC Medicaid |
$5,535.34
|
| Rate for Payer: UHCCP Medicaid |
$5,535.34
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$11,418.62
|
|
|
Service Code
|
APR-DRG 3143
|
| Min. Negotiated Rate |
$10,874.87 |
| Max. Negotiated Rate |
$11,418.62 |
| Rate for Payer: BCBS Complete |
$11,418.62
|
| Rate for Payer: Mclaren Medicaid |
$10,874.87
|
| Rate for Payer: Meridian Medicaid |
$11,418.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,874.87
|
| Rate for Payer: UHC Medicaid |
$10,874.87
|
| Rate for Payer: UHCCP Medicaid |
$10,874.87
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$15,383.98
|
|
|
Service Code
|
APR-DRG 3144
|
| Min. Negotiated Rate |
$14,651.40 |
| Max. Negotiated Rate |
$15,383.98 |
| Rate for Payer: BCBS Complete |
$15,383.98
|
| Rate for Payer: Mclaren Medicaid |
$14,651.40
|
| Rate for Payer: Meridian Medicaid |
$15,383.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,651.40
|
| Rate for Payer: UHC Medicaid |
$14,651.40
|
| Rate for Payer: UHCCP Medicaid |
$14,651.40
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$85.84
|
|
|
Service Code
|
NDC 69097057967
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.74 |
| Max. Negotiated Rate |
$77.26 |
| Rate for Payer: Aetna Commercial |
$72.96
|
| Rate for Payer: BCBS Trust/PPO |
$70.90
|
| Rate for Payer: BCN Commercial |
$70.90
|
| Rate for Payer: Cash Price |
$68.67
|
| Rate for Payer: Cofinity Commercial |
$73.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.67
|
| Rate for Payer: Healthscope Commercial |
$77.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.96
|
| Rate for Payer: Nomi Health Commercial |
$70.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.38
|
| Rate for Payer: PHP Commercial |
$72.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.54
|
| Rate for Payer: UHC Core |
$71.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.38
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$194.25
|
|
|
Service Code
|
NDC 70700026899
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.25 |
| Max. Negotiated Rate |
$174.82 |
| Rate for Payer: Aetna Commercial |
$165.11
|
| Rate for Payer: Aetna Medicare |
$50.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.70
|
| Rate for Payer: BCBS Complete |
$35.96
|
| Rate for Payer: BCBS MAPPO |
$48.56
|
| Rate for Payer: BCBS Trust/PPO |
$159.69
|
| Rate for Payer: BCN Commercial |
$159.69
|
| Rate for Payer: BCN Medicare Advantage |
$48.56
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Commercial |
$167.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.56
|
| Rate for Payer: Healthscope Commercial |
$174.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.69
|
| Rate for Payer: Mclaren Medicaid |
$34.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.99
|
| Rate for Payer: Meridian Medicaid |
$35.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: Nomi Health Commercial |
$159.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.69
|
| Rate for Payer: PACE Senior Care Partners |
$46.13
|
| Rate for Payer: PACE SWMI |
$48.56
|
| Rate for Payer: PHP Commercial |
$165.11
|
| Rate for Payer: PHP Medicare Advantage |
$48.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$169.00
|
| Rate for Payer: Priority Health Medicare |
$49.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.20
|
| Rate for Payer: Railroad Medicare Medicare |
$48.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.94
|
| Rate for Payer: UHC Core |
$162.20
|
| Rate for Payer: UHC Exchange |
$48.56
|
| Rate for Payer: UHC Medicaid |
$34.25
|
| Rate for Payer: UHC Medicare Advantage |
$48.56
|
| Rate for Payer: UHCCP Medicaid |
$34.25
|
| Rate for Payer: VA VA |
$48.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.69
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$194.25
|
|
|
Service Code
|
NDC 70700026894
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.20 |
| Max. Negotiated Rate |
$174.82 |
| Rate for Payer: Aetna Commercial |
$165.11
|
| Rate for Payer: BCBS Trust/PPO |
$160.43
|
| Rate for Payer: BCN Commercial |
$160.43
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Commercial |
$167.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Healthscope Commercial |
$174.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: Nomi Health Commercial |
$159.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.69
|
| Rate for Payer: PHP Commercial |
$165.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$169.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.94
|
| Rate for Payer: UHC Core |
$162.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.69
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$194.25
|
|
|
Service Code
|
NDC 70700026899
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.20 |
| Max. Negotiated Rate |
$174.82 |
| Rate for Payer: Aetna Commercial |
$165.11
|
| Rate for Payer: BCBS Trust/PPO |
$160.43
|
| Rate for Payer: BCN Commercial |
$160.43
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Commercial |
$167.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Healthscope Commercial |
$174.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: Nomi Health Commercial |
$159.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.69
|
| Rate for Payer: PHP Commercial |
$165.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$169.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.94
|
| Rate for Payer: UHC Core |
$162.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.69
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$194.25
|
|
|
Service Code
|
NDC 70700026894
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.25 |
| Max. Negotiated Rate |
$174.82 |
| Rate for Payer: Aetna Commercial |
$165.11
|
| Rate for Payer: Aetna Medicare |
$50.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.70
|
| Rate for Payer: BCBS Complete |
$35.96
|
| Rate for Payer: BCBS MAPPO |
$48.56
|
| Rate for Payer: BCBS Trust/PPO |
$159.69
|
| Rate for Payer: BCN Commercial |
$159.69
|
| Rate for Payer: BCN Medicare Advantage |
$48.56
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Commercial |
$167.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.56
|
| Rate for Payer: Healthscope Commercial |
$174.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.69
|
| Rate for Payer: Mclaren Medicaid |
$34.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.99
|
| Rate for Payer: Meridian Medicaid |
$35.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: Nomi Health Commercial |
$159.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.69
|
| Rate for Payer: PACE Senior Care Partners |
$46.13
|
| Rate for Payer: PACE SWMI |
$48.56
|
| Rate for Payer: PHP Commercial |
$165.11
|
| Rate for Payer: PHP Medicare Advantage |
$48.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$169.00
|
| Rate for Payer: Priority Health Medicare |
$49.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.20
|
| Rate for Payer: Railroad Medicare Medicare |
$48.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.94
|
| Rate for Payer: UHC Core |
$162.20
|
| Rate for Payer: UHC Exchange |
$48.56
|
| Rate for Payer: UHC Medicaid |
$34.25
|
| Rate for Payer: UHC Medicare Advantage |
$48.56
|
| Rate for Payer: UHCCP Medicaid |
$34.25
|
| Rate for Payer: VA VA |
$48.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.69
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$85.84
|
|
|
Service Code
|
NDC 69097057967
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$77.26 |
| Rate for Payer: Aetna Commercial |
$72.96
|
| Rate for Payer: Aetna Medicare |
$22.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.82
|
| Rate for Payer: BCBS Complete |
$15.89
|
| Rate for Payer: BCBS MAPPO |
$21.46
|
| Rate for Payer: BCBS Trust/PPO |
$70.57
|
| Rate for Payer: BCN Commercial |
$70.57
|
| Rate for Payer: BCN Medicare Advantage |
$21.46
|
| Rate for Payer: Cash Price |
$68.67
|
| Rate for Payer: Cofinity Commercial |
$73.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$77.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.38
|
| Rate for Payer: Mclaren Medicaid |
$15.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.53
|
| Rate for Payer: Meridian Medicaid |
$15.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.96
|
| Rate for Payer: Nomi Health Commercial |
$70.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.38
|
| Rate for Payer: PACE Senior Care Partners |
$20.39
|
| Rate for Payer: PACE SWMI |
$21.46
|
| Rate for Payer: PHP Commercial |
$72.96
|
| Rate for Payer: PHP Medicare Advantage |
$21.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.68
|
| Rate for Payer: Priority Health Medicare |
$21.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.74
|
| Rate for Payer: Railroad Medicare Medicare |
$21.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.54
|
| Rate for Payer: UHC Core |
$71.68
|
| Rate for Payer: UHC Exchange |
$21.46
|
| Rate for Payer: UHC Medicaid |
$15.13
|
| Rate for Payer: UHC Medicare Advantage |
$21.46
|
| Rate for Payer: UHCCP Medicaid |
$15.13
|
| Rate for Payer: VA VA |
$21.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.38
|
|
|
FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION
|
Facility
|
OP
|
$22.65
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
17764
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$20.39 |
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Aetna Medicare |
$5.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.08
|
| Rate for Payer: BCBS Complete |
$4.19
|
| Rate for Payer: BCBS MAPPO |
$5.66
|
| Rate for Payer: BCBS Trust/PPO |
$18.62
|
| Rate for Payer: BCN Commercial |
$18.62
|
| Rate for Payer: BCN Medicare Advantage |
$5.66
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.66
|
| Rate for Payer: Healthscope Commercial |
$20.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.99
|
| Rate for Payer: Mclaren Medicaid |
$3.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.95
|
| Rate for Payer: Meridian Medicaid |
$4.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.25
|
| Rate for Payer: Nomi Health Commercial |
$18.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.99
|
| Rate for Payer: PACE Senior Care Partners |
$5.38
|
| Rate for Payer: PACE SWMI |
$5.66
|
| Rate for Payer: PHP Commercial |
$19.25
|
| Rate for Payer: PHP Medicare Advantage |
$5.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.71
|
| Rate for Payer: Priority Health Medicare |
$5.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.93
|
| Rate for Payer: UHC Core |
$18.91
|
| Rate for Payer: UHC Exchange |
$5.66
|
| Rate for Payer: UHC Medicaid |
$3.99
|
| Rate for Payer: UHC Medicare Advantage |
$5.66
|
| Rate for Payer: UHCCP Medicaid |
$3.99
|
| Rate for Payer: VA VA |
$5.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.99
|
|
|
FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$22.65
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
17764
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$20.39 |
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: BCBS Trust/PPO |
$18.71
|
| Rate for Payer: BCN Commercial |
$18.71
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.12
|
| Rate for Payer: Healthscope Commercial |
$20.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.25
|
| Rate for Payer: Nomi Health Commercial |
$18.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.99
|
| Rate for Payer: PHP Commercial |
$19.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.93
|
| Rate for Payer: UHC Core |
$18.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.99
|
|
|
FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION
|
Facility
|
OP
|
$400.44
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
88010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.60 |
| Max. Negotiated Rate |
$360.40 |
| Rate for Payer: Aetna Commercial |
$340.37
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna Commercial |
$34.84
|
| Rate for Payer: Aetna Medicare |
$18.20
|
| Rate for Payer: Aetna Medicare |
$104.11
|
| Rate for Payer: Aetna Medicare |
$10.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.88
|
| Rate for Payer: BCBS Complete |
$7.59
|
| Rate for Payer: BCBS Complete |
$74.12
|
| Rate for Payer: BCBS Complete |
$12.96
|
| Rate for Payer: BCBS MAPPO |
$17.50
|
| Rate for Payer: BCBS MAPPO |
$100.11
|
| Rate for Payer: BCBS MAPPO |
$10.25
|
| Rate for Payer: BCBS Trust/PPO |
$329.20
|
| Rate for Payer: BCBS Trust/PPO |
$33.70
|
| Rate for Payer: BCBS Trust/PPO |
$57.55
|
| Rate for Payer: BCN Commercial |
$33.70
|
| Rate for Payer: BCN Commercial |
$57.55
|
| Rate for Payer: BCN Commercial |
$329.20
|
| Rate for Payer: BCN Medicare Advantage |
$17.50
|
| Rate for Payer: BCN Medicare Advantage |
$10.25
|
| Rate for Payer: BCN Medicare Advantage |
$100.11
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$32.79
|
| Rate for Payer: Cash Price |
$320.35
|
| Rate for Payer: Cofinity Commercial |
$344.38
|
| Rate for Payer: Cofinity Commercial |
$35.25
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.11
|
| Rate for Payer: Healthscope Commercial |
$36.89
|
| Rate for Payer: Healthscope Commercial |
$360.40
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.74
|
| Rate for Payer: Mclaren Medicaid |
$70.60
|
| Rate for Payer: Mclaren Medicaid |
$12.34
|
| Rate for Payer: Mclaren Medicaid |
$7.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.38
|
| Rate for Payer: Meridian Medicaid |
$12.96
|
| Rate for Payer: Meridian Medicaid |
$74.12
|
| Rate for Payer: Meridian Medicaid |
$7.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$110.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.84
|
| Rate for Payer: Nomi Health Commercial |
$57.40
|
| Rate for Payer: Nomi Health Commercial |
$33.61
|
| Rate for Payer: Nomi Health Commercial |
$328.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.33
|
| Rate for Payer: PACE Senior Care Partners |
$9.74
|
| Rate for Payer: PACE Senior Care Partners |
$95.10
|
| Rate for Payer: PACE Senior Care Partners |
$16.62
|
| Rate for Payer: PACE SWMI |
$17.50
|
| Rate for Payer: PACE SWMI |
$10.25
|
| Rate for Payer: PACE SWMI |
$100.11
|
| Rate for Payer: PHP Commercial |
$340.37
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: PHP Commercial |
$34.84
|
| Rate for Payer: PHP Medicare Advantage |
$10.25
|
| Rate for Payer: PHP Medicare Advantage |
$100.11
|
| Rate for Payer: PHP Medicare Advantage |
$17.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$35.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$348.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.90
|
| Rate for Payer: Priority Health Medicare |
$17.68
|
| Rate for Payer: Priority Health Medicare |
$10.35
|
| Rate for Payer: Priority Health Medicare |
$101.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$278.71
|
| Rate for Payer: Railroad Medicare Medicare |
$10.25
|
| Rate for Payer: Railroad Medicare Medicare |
$17.50
|
| Rate for Payer: Railroad Medicare Medicare |
$100.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.39
|
| Rate for Payer: UHC Core |
$334.37
|
| Rate for Payer: UHC Core |
$58.45
|
| Rate for Payer: UHC Core |
$34.23
|
| Rate for Payer: UHC Exchange |
$17.50
|
| Rate for Payer: UHC Exchange |
$10.25
|
| Rate for Payer: UHC Exchange |
$100.11
|
| Rate for Payer: UHC Medicaid |
$70.60
|
| Rate for Payer: UHC Medicaid |
$12.34
|
| Rate for Payer: UHC Medicaid |
$7.23
|
| Rate for Payer: UHC Medicare Advantage |
$10.25
|
| Rate for Payer: UHC Medicare Advantage |
$100.11
|
| Rate for Payer: UHC Medicare Advantage |
$17.50
|
| Rate for Payer: UHCCP Medicaid |
$7.23
|
| Rate for Payer: UHCCP Medicaid |
$70.60
|
| Rate for Payer: UHCCP Medicaid |
$12.34
|
| Rate for Payer: VA VA |
$100.11
|
| Rate for Payer: VA VA |
$17.50
|
| Rate for Payer: VA VA |
$10.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION
|
Facility
|
IP
|
$400.44
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
88010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$278.71 |
| Max. Negotiated Rate |
$360.40 |
| Rate for Payer: Aetna Commercial |
$340.37
|
| Rate for Payer: Aetna Commercial |
$34.84
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: BCBS Trust/PPO |
$33.85
|
| Rate for Payer: BCBS Trust/PPO |
$330.72
|
| Rate for Payer: BCBS Trust/PPO |
$57.81
|
| Rate for Payer: BCN Commercial |
$33.85
|
| Rate for Payer: BCN Commercial |
$330.72
|
| Rate for Payer: BCN Commercial |
$57.81
|
| Rate for Payer: Cash Price |
$320.35
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$32.79
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Cofinity Commercial |
$35.25
|
| Rate for Payer: Cofinity Commercial |
$344.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$36.89
|
| Rate for Payer: Healthscope Commercial |
$360.40
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.50
|
| Rate for Payer: Nomi Health Commercial |
$328.36
|
| Rate for Payer: Nomi Health Commercial |
$33.61
|
| Rate for Payer: Nomi Health Commercial |
$57.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.50
|
| Rate for Payer: PHP Commercial |
$340.37
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: PHP Commercial |
$34.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$35.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$348.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$278.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.39
|
| Rate for Payer: UHC Core |
$334.37
|
| Rate for Payer: UHC Core |
$58.45
|
| Rate for Payer: UHC Core |
$34.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.74
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$11,214.06
|
|
|
Service Code
|
APR-DRG 3404
|
| Min. Negotiated Rate |
$10,680.06 |
| Max. Negotiated Rate |
$11,214.06 |
| Rate for Payer: BCBS Complete |
$11,214.06
|
| Rate for Payer: Mclaren Medicaid |
$10,680.06
|
| Rate for Payer: Meridian Medicaid |
$11,214.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,680.06
|
| Rate for Payer: UHC Medicaid |
$10,680.06
|
| Rate for Payer: UHCCP Medicaid |
$10,680.06
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$4,097.35
|
|
|
Service Code
|
APR-DRG 3402
|
| Min. Negotiated Rate |
$3,902.23 |
| Max. Negotiated Rate |
$4,097.35 |
| Rate for Payer: BCBS Complete |
$4,097.35
|
| Rate for Payer: Mclaren Medicaid |
$3,902.23
|
| Rate for Payer: Meridian Medicaid |
$4,097.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,902.23
|
| Rate for Payer: UHC Medicaid |
$3,902.23
|
| Rate for Payer: UHCCP Medicaid |
$3,902.23
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$7,521.62
|
|
|
Service Code
|
APR-DRG 3403
|
| Min. Negotiated Rate |
$7,163.44 |
| Max. Negotiated Rate |
$7,521.62 |
| Rate for Payer: BCBS Complete |
$7,521.62
|
| Rate for Payer: Mclaren Medicaid |
$7,163.44
|
| Rate for Payer: Meridian Medicaid |
$7,521.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,163.44
|
| Rate for Payer: UHC Medicaid |
$7,163.44
|
| Rate for Payer: UHCCP Medicaid |
$7,163.44
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$3,172.39
|
|
|
Service Code
|
APR-DRG 3401
|
| Min. Negotiated Rate |
$3,021.33 |
| Max. Negotiated Rate |
$3,172.39 |
| Rate for Payer: BCBS Complete |
$3,172.39
|
| Rate for Payer: Mclaren Medicaid |
$3,021.33
|
| Rate for Payer: Meridian Medicaid |
$3,172.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,021.33
|
| Rate for Payer: UHC Medicaid |
$3,021.33
|
| Rate for Payer: UHCCP Medicaid |
$3,021.33
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$15,615.34
|
|
|
Service Code
|
APR-DRG 3414
|
| Min. Negotiated Rate |
$14,871.76 |
| Max. Negotiated Rate |
$15,615.34 |
| Rate for Payer: BCBS Complete |
$15,615.34
|
| Rate for Payer: Mclaren Medicaid |
$14,871.76
|
| Rate for Payer: Meridian Medicaid |
$15,615.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,871.76
|
| Rate for Payer: UHC Medicaid |
$14,871.76
|
| Rate for Payer: UHCCP Medicaid |
$14,871.76
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$9,064.43
|
|
|
Service Code
|
APR-DRG 3413
|
| Min. Negotiated Rate |
$8,632.79 |
| Max. Negotiated Rate |
$9,064.43 |
| Rate for Payer: BCBS Complete |
$9,064.43
|
| Rate for Payer: Mclaren Medicaid |
$8,632.79
|
| Rate for Payer: Meridian Medicaid |
$9,064.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,632.79
|
| Rate for Payer: UHC Medicaid |
$8,632.79
|
| Rate for Payer: UHCCP Medicaid |
$8,632.79
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$4,227.23
|
|
|
Service Code
|
APR-DRG 3412
|
| Min. Negotiated Rate |
$4,025.93 |
| Max. Negotiated Rate |
$4,227.23 |
| Rate for Payer: BCBS Complete |
$4,227.23
|
| Rate for Payer: Mclaren Medicaid |
$4,025.93
|
| Rate for Payer: Meridian Medicaid |
$4,227.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,025.93
|
| Rate for Payer: UHC Medicaid |
$4,025.93
|
| Rate for Payer: UHCCP Medicaid |
$4,025.93
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$2,979.94
|
|
|
Service Code
|
APR-DRG 3411
|
| Min. Negotiated Rate |
$2,838.03 |
| Max. Negotiated Rate |
$2,979.94 |
| Rate for Payer: BCBS Complete |
$2,979.94
|
| Rate for Payer: Mclaren Medicaid |
$2,838.03
|
| Rate for Payer: Meridian Medicaid |
$2,979.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,838.03
|
| Rate for Payer: UHC Medicaid |
$2,838.03
|
| Rate for Payer: UHCCP Medicaid |
$2,838.03
|
|
|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$6,920.58
|
|
|
Service Code
|
APR-DRG 3423
|
| Min. Negotiated Rate |
$6,591.03 |
| Max. Negotiated Rate |
$6,920.58 |
| Rate for Payer: BCBS Complete |
$6,920.58
|
| Rate for Payer: Mclaren Medicaid |
$6,591.03
|
| Rate for Payer: Meridian Medicaid |
$6,920.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,591.03
|
| Rate for Payer: UHC Medicaid |
$6,591.03
|
| Rate for Payer: UHCCP Medicaid |
$6,591.03
|
|
|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$12,392.47
|
|
|
Service Code
|
APR-DRG 3424
|
| Min. Negotiated Rate |
$11,802.35 |
| Max. Negotiated Rate |
$12,392.47 |
| Rate for Payer: BCBS Complete |
$12,392.47
|
| Rate for Payer: Mclaren Medicaid |
$11,802.35
|
| Rate for Payer: Meridian Medicaid |
$12,392.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,802.35
|
| Rate for Payer: UHC Medicaid |
$11,802.35
|
| Rate for Payer: UHCCP Medicaid |
$11,802.35
|
|
|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$4,209.88
|
|
|
Service Code
|
APR-DRG 3421
|
| Min. Negotiated Rate |
$4,009.40 |
| Max. Negotiated Rate |
$4,209.88 |
| Rate for Payer: BCBS Complete |
$4,209.88
|
| Rate for Payer: Mclaren Medicaid |
$4,009.40
|
| Rate for Payer: Meridian Medicaid |
$4,209.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,009.40
|
| Rate for Payer: UHC Medicaid |
$4,009.40
|
| Rate for Payer: UHCCP Medicaid |
$4,009.40
|
|
