|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$213.63
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
106783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$192.27 |
| Rate for Payer: Aetna American Axle |
$138.86
|
| Rate for Payer: Aetna American Axle |
$960.86
|
| Rate for Payer: Aetna American Axle |
$166.24
|
| Rate for Payer: Aetna American Axle |
$278.76
|
| Rate for Payer: Aetna American Axle |
$126.83
|
| Rate for Payer: Aetna Commercial |
$1,256.51
|
| Rate for Payer: Aetna Commercial |
$181.59
|
| Rate for Payer: Aetna Commercial |
$217.39
|
| Rate for Payer: Aetna Commercial |
$165.86
|
| Rate for Payer: Aetna Commercial |
$364.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.24
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$1,182.60
|
| Rate for Payer: Cash Price |
$343.09
|
| Rate for Payer: Cash Price |
$170.90
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: Cofinity Commercial |
$368.82
|
| Rate for Payer: Cofinity Commercial |
$1,034.78
|
| Rate for Payer: Cofinity Commercial |
$1,271.30
|
| Rate for Payer: Cofinity Commercial |
$219.94
|
| Rate for Payer: Cofinity Commercial |
$179.02
|
| Rate for Payer: Cofinity Commercial |
$136.59
|
| Rate for Payer: Cofinity Commercial |
$167.81
|
| Rate for Payer: Cofinity Commercial |
$183.72
|
| Rate for Payer: Cofinity Commercial |
$149.54
|
| Rate for Payer: Cofinity Commercial |
$300.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.09
|
| Rate for Payer: Healthscope Commercial |
$230.18
|
| Rate for Payer: Healthscope Commercial |
$192.27
|
| Rate for Payer: Healthscope Commercial |
$175.62
|
| Rate for Payer: Healthscope Commercial |
$385.97
|
| Rate for Payer: Healthscope Commercial |
$1,330.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,034.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,108.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,256.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$181.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.53
|
| Rate for Payer: PHP Commercial |
$165.86
|
| Rate for Payer: PHP Commercial |
$1,256.51
|
| Rate for Payer: PHP Commercial |
$181.59
|
| Rate for Payer: PHP Commercial |
$217.39
|
| Rate for Payer: PHP Commercial |
$364.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.59
|
| Rate for Payer: Priority Health SBD |
$161.12
|
| Rate for Payer: Priority Health SBD |
$122.93
|
| Rate for Payer: Priority Health SBD |
$134.59
|
| Rate for Payer: Priority Health SBD |
$931.30
|
| Rate for Payer: Priority Health SBD |
$270.18
|
| Rate for Payer: UMR Bronson Commercial |
$188.70
|
| Rate for Payer: UMR Bronson Commercial |
$112.53
|
| Rate for Payer: UMR Bronson Commercial |
$85.86
|
| Rate for Payer: UMR Bronson Commercial |
$650.43
|
| Rate for Payer: UMR Bronson Commercial |
$94.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,108.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.22
|
|
|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$267.38
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
106783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$240.64 |
| Rate for Payer: Aetna American Axle |
$173.80
|
| Rate for Payer: Aetna American Axle |
$126.83
|
| Rate for Payer: Aetna American Axle |
$873.86
|
| Rate for Payer: Aetna American Axle |
$166.24
|
| Rate for Payer: Aetna American Axle |
$151.12
|
| Rate for Payer: Aetna American Axle |
$170.06
|
| Rate for Payer: Aetna American Axle |
$960.86
|
| Rate for Payer: Aetna American Axle |
$278.76
|
| Rate for Payer: Aetna American Axle |
$123.79
|
| Rate for Payer: Aetna American Axle |
$141.46
|
| Rate for Payer: Aetna American Axle |
$138.86
|
| Rate for Payer: Aetna Commercial |
$1,256.51
|
| Rate for Payer: Aetna Commercial |
$181.59
|
| Rate for Payer: Aetna Commercial |
$197.62
|
| Rate for Payer: Aetna Commercial |
$217.39
|
| Rate for Payer: Aetna Commercial |
$165.86
|
| Rate for Payer: Aetna Commercial |
$161.88
|
| Rate for Payer: Aetna Commercial |
$222.39
|
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Commercial |
$184.99
|
| Rate for Payer: Aetna Commercial |
$364.53
|
| Rate for Payer: Aetna Commercial |
$1,142.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.76
|
| Rate for Payer: BCBS Complete |
$87.05
|
| Rate for Payer: BCBS Complete |
$591.30
|
| Rate for Payer: BCBS Complete |
$102.30
|
| Rate for Payer: BCBS Complete |
$104.65
|
| Rate for Payer: BCBS Complete |
$106.95
|
| Rate for Payer: BCBS Complete |
$85.45
|
| Rate for Payer: BCBS Complete |
$171.54
|
| Rate for Payer: BCBS Complete |
$78.05
|
| Rate for Payer: BCBS Complete |
$76.18
|
| Rate for Payer: BCBS Complete |
$537.76
|
| Rate for Payer: BCBS Complete |
$93.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: Cash Price |
$343.09
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$1,075.52
|
| Rate for Payer: Cash Price |
$1,075.52
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$1,182.60
|
| Rate for Payer: Cash Price |
$1,182.60
|
| Rate for Payer: Cash Price |
$343.09
|
| Rate for Payer: Cash Price |
$152.36
|
| Rate for Payer: Cash Price |
$152.36
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$170.90
|
| Rate for Payer: Cash Price |
$170.90
|
| Rate for Payer: Cash Price |
$209.30
|
| Rate for Payer: Cash Price |
$174.10
|
| Rate for Payer: Cash Price |
$174.10
|
| Rate for Payer: Cash Price |
$209.30
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cofinity Commercial |
$1,034.78
|
| Rate for Payer: Cofinity Commercial |
$167.81
|
| Rate for Payer: Cofinity Commercial |
$1,271.30
|
| Rate for Payer: Cofinity Commercial |
$152.34
|
| Rate for Payer: Cofinity Commercial |
$187.16
|
| Rate for Payer: Cofinity Commercial |
$199.95
|
| Rate for Payer: Cofinity Commercial |
$149.54
|
| Rate for Payer: Cofinity Commercial |
$183.72
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Commercial |
$162.75
|
| Rate for Payer: Cofinity Commercial |
$179.02
|
| Rate for Payer: Cofinity Commercial |
$187.17
|
| Rate for Payer: Cofinity Commercial |
$941.08
|
| Rate for Payer: Cofinity Commercial |
$219.94
|
| Rate for Payer: Cofinity Commercial |
$136.59
|
| Rate for Payer: Cofinity Commercial |
$225.00
|
| Rate for Payer: Cofinity Commercial |
$183.14
|
| Rate for Payer: Cofinity Commercial |
$1,156.18
|
| Rate for Payer: Cofinity Commercial |
$163.79
|
| Rate for Payer: Cofinity Commercial |
$368.82
|
| Rate for Payer: Cofinity Commercial |
$133.32
|
| Rate for Payer: Cofinity Commercial |
$300.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,075.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.00
|
| Rate for Payer: Healthscope Commercial |
$192.27
|
| Rate for Payer: Healthscope Commercial |
$1,209.96
|
| Rate for Payer: Healthscope Commercial |
$209.25
|
| Rate for Payer: Healthscope Commercial |
$175.62
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$171.40
|
| Rate for Payer: Healthscope Commercial |
$195.87
|
| Rate for Payer: Healthscope Commercial |
$235.47
|
| Rate for Payer: Healthscope Commercial |
$230.18
|
| Rate for Payer: Healthscope Commercial |
$1,330.42
|
| Rate for Payer: Healthscope Commercial |
$385.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,034.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$941.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,008.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,108.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$222.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,142.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,256.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$181.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.86
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$222.39
|
| Rate for Payer: PHP Commercial |
$197.62
|
| Rate for Payer: PHP Commercial |
$165.86
|
| Rate for Payer: PHP Commercial |
$217.39
|
| Rate for Payer: PHP Commercial |
$364.53
|
| Rate for Payer: PHP Commercial |
$184.99
|
| Rate for Payer: PHP Commercial |
$181.59
|
| Rate for Payer: PHP Commercial |
$1,142.74
|
| Rate for Payer: PHP Commercial |
$161.88
|
| Rate for Payer: PHP Commercial |
$1,256.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.75
|
| Rate for Payer: Priority Health SBD |
$846.97
|
| Rate for Payer: Priority Health SBD |
$122.93
|
| Rate for Payer: Priority Health SBD |
$161.12
|
| Rate for Payer: Priority Health SBD |
$270.18
|
| Rate for Payer: Priority Health SBD |
$146.48
|
| Rate for Payer: Priority Health SBD |
$137.11
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: Priority Health SBD |
$119.98
|
| Rate for Payer: Priority Health SBD |
$931.30
|
| Rate for Payer: Priority Health SBD |
$164.83
|
| Rate for Payer: Priority Health SBD |
$134.59
|
| Rate for Payer: UMR Bronson Commercial |
$79.04
|
| Rate for Payer: UMR Bronson Commercial |
$86.02
|
| Rate for Payer: UMR Bronson Commercial |
$98.93
|
| Rate for Payer: UMR Bronson Commercial |
$94.63
|
| Rate for Payer: UMR Bronson Commercial |
$158.68
|
| Rate for Payer: UMR Bronson Commercial |
$70.47
|
| Rate for Payer: UMR Bronson Commercial |
$80.52
|
| Rate for Payer: UMR Bronson Commercial |
$546.95
|
| Rate for Payer: UMR Bronson Commercial |
$72.20
|
| Rate for Payer: UMR Bronson Commercial |
$497.43
|
| Rate for Payer: UMR Bronson Commercial |
$96.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,108.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,008.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.35
|
|
|
FOSCARNET 24 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,061.45
|
|
|
Service Code
|
HCPCS J1455
|
| Hospital Charge Code |
10093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$467.04 |
| Max. Negotiated Rate |
$955.30 |
| Rate for Payer: Aetna American Axle |
$689.94
|
| Rate for Payer: Aetna Commercial |
$902.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$689.94
|
| Rate for Payer: Cash Price |
$849.16
|
| Rate for Payer: Cofinity Commercial |
$743.02
|
| Rate for Payer: Cofinity Commercial |
$912.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$849.16
|
| Rate for Payer: Healthscope Commercial |
$955.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$743.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$796.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$902.23
|
| Rate for Payer: PHP Commercial |
$902.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$743.02
|
| Rate for Payer: Priority Health SBD |
$668.71
|
| Rate for Payer: UMR Bronson Commercial |
$467.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$796.09
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$206.46
|
|
|
Service Code
|
NDC 82036-4274-8
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.84 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna American Axle |
$134.20
|
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.20
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$144.52
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.49
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.52
|
| Rate for Payer: Priority Health SBD |
$130.07
|
| Rate for Payer: UMR Bronson Commercial |
$90.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$206.46
|
|
|
Service Code
|
NDC 82036-4274-1
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.84 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna American Axle |
$134.20
|
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.20
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$144.52
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.49
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.52
|
| Rate for Payer: Priority Health SBD |
$130.07
|
| Rate for Payer: UMR Bronson Commercial |
$90.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$190.41
|
|
|
Service Code
|
NDC 70700-268-94
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.78 |
| Max. Negotiated Rate |
$171.37 |
| Rate for Payer: Aetna American Axle |
$123.77
|
| Rate for Payer: Aetna Commercial |
$161.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.77
|
| Rate for Payer: Cash Price |
$152.33
|
| Rate for Payer: Cofinity Commercial |
$133.29
|
| Rate for Payer: Cofinity Commercial |
$163.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.33
|
| Rate for Payer: Healthscope Commercial |
$171.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.85
|
| Rate for Payer: PHP Commercial |
$161.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.29
|
| Rate for Payer: Priority Health SBD |
$119.96
|
| Rate for Payer: UMR Bronson Commercial |
$83.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.81
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$190.41
|
|
|
Service Code
|
NDC 70700-268-99
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.78 |
| Max. Negotiated Rate |
$171.37 |
| Rate for Payer: Aetna American Axle |
$123.77
|
| Rate for Payer: Aetna Commercial |
$161.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.77
|
| Rate for Payer: Cash Price |
$152.33
|
| Rate for Payer: Cofinity Commercial |
$133.29
|
| Rate for Payer: Cofinity Commercial |
$163.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.33
|
| Rate for Payer: Healthscope Commercial |
$171.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.85
|
| Rate for Payer: PHP Commercial |
$161.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.29
|
| Rate for Payer: Priority Health SBD |
$119.96
|
| Rate for Payer: UMR Bronson Commercial |
$83.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.81
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$241.84
|
|
|
Service Code
|
NDC 0456-4300-01
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.41 |
| Max. Negotiated Rate |
$217.66 |
| Rate for Payer: Aetna American Axle |
$157.20
|
| Rate for Payer: Aetna Commercial |
$205.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.20
|
| Rate for Payer: Cash Price |
$193.47
|
| Rate for Payer: Cofinity Commercial |
$169.29
|
| Rate for Payer: Cofinity Commercial |
$207.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.47
|
| Rate for Payer: Healthscope Commercial |
$217.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.56
|
| Rate for Payer: PHP Commercial |
$205.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.29
|
| Rate for Payer: Priority Health SBD |
$152.36
|
| Rate for Payer: UMR Bronson Commercial |
$106.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.38
|
|
|
FOSINOPRIL 20 MG TABLET
|
Facility
|
IP
|
$253.80
|
|
|
Service Code
|
NDC 69097-857-05
|
| Hospital Charge Code |
10095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.67 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna American Axle |
$164.97
|
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.97
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$177.66
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.73
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.66
|
| Rate for Payer: Priority Health SBD |
$159.89
|
| Rate for Payer: UMR Bronson Commercial |
$111.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.35
|
|
|
FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$15.52
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
17764
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$13.97 |
| Rate for Payer: Aetna American Axle |
$10.09
|
| Rate for Payer: Aetna American Axle |
$12.92
|
| Rate for Payer: Aetna American Axle |
$18.23
|
| Rate for Payer: Aetna Commercial |
$16.89
|
| Rate for Payer: Aetna Commercial |
$23.84
|
| Rate for Payer: Aetna Commercial |
$13.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.92
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$22.44
|
| Rate for Payer: Cofinity Commercial |
$19.64
|
| Rate for Payer: Cofinity Commercial |
$13.35
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$10.86
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$24.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.90
|
| Rate for Payer: Healthscope Commercial |
$13.97
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: Healthscope Commercial |
$25.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.19
|
| Rate for Payer: PHP Commercial |
$23.84
|
| Rate for Payer: PHP Commercial |
$13.19
|
| Rate for Payer: PHP Commercial |
$16.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.86
|
| Rate for Payer: Priority Health SBD |
$17.67
|
| Rate for Payer: Priority Health SBD |
$9.78
|
| Rate for Payer: Priority Health SBD |
$12.52
|
| Rate for Payer: UMR Bronson Commercial |
$6.83
|
| Rate for Payer: UMR Bronson Commercial |
$8.74
|
| Rate for Payer: UMR Bronson Commercial |
$12.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.64
|
|
|
FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION
|
Facility
|
IP
|
$65.33
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
88010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.75 |
| Max. Negotiated Rate |
$58.80 |
| Rate for Payer: Aetna American Axle |
$42.46
|
| Rate for Payer: Aetna American Axle |
$85.36
|
| Rate for Payer: Aetna American Axle |
$34.54
|
| Rate for Payer: Aetna American Axle |
$60.54
|
| Rate for Payer: Aetna American Axle |
$40.21
|
| Rate for Payer: Aetna American Axle |
$59.04
|
| Rate for Payer: Aetna Commercial |
$52.58
|
| Rate for Payer: Aetna Commercial |
$55.53
|
| Rate for Payer: Aetna Commercial |
$45.17
|
| Rate for Payer: Aetna Commercial |
$111.62
|
| Rate for Payer: Aetna Commercial |
$79.17
|
| Rate for Payer: Aetna Commercial |
$77.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.46
|
| Rate for Payer: Cash Price |
$74.51
|
| Rate for Payer: Cash Price |
$42.51
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Cash Price |
$72.66
|
| Rate for Payer: Cash Price |
$52.26
|
| Rate for Payer: Cash Price |
$49.49
|
| Rate for Payer: Cofinity Commercial |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$53.20
|
| Rate for Payer: Cofinity Commercial |
$80.10
|
| Rate for Payer: Cofinity Commercial |
$45.73
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Cofinity Commercial |
$37.20
|
| Rate for Payer: Cofinity Commercial |
$43.30
|
| Rate for Payer: Cofinity Commercial |
$112.94
|
| Rate for Payer: Cofinity Commercial |
$91.92
|
| Rate for Payer: Cofinity Commercial |
$78.11
|
| Rate for Payer: Cofinity Commercial |
$63.58
|
| Rate for Payer: Cofinity Commercial |
$56.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.49
|
| Rate for Payer: Healthscope Commercial |
$55.67
|
| Rate for Payer: Healthscope Commercial |
$81.75
|
| Rate for Payer: Healthscope Commercial |
$47.83
|
| Rate for Payer: Healthscope Commercial |
$58.80
|
| Rate for Payer: Healthscope Commercial |
$83.83
|
| Rate for Payer: Healthscope Commercial |
$118.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.62
|
| Rate for Payer: PHP Commercial |
$77.21
|
| Rate for Payer: PHP Commercial |
$55.53
|
| Rate for Payer: PHP Commercial |
$111.62
|
| Rate for Payer: PHP Commercial |
$52.58
|
| Rate for Payer: PHP Commercial |
$45.17
|
| Rate for Payer: PHP Commercial |
$79.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.30
|
| Rate for Payer: Priority Health SBD |
$57.22
|
| Rate for Payer: Priority Health SBD |
$58.68
|
| Rate for Payer: Priority Health SBD |
$38.97
|
| Rate for Payer: Priority Health SBD |
$82.73
|
| Rate for Payer: Priority Health SBD |
$33.48
|
| Rate for Payer: Priority Health SBD |
$41.16
|
| Rate for Payer: UMR Bronson Commercial |
$23.38
|
| Rate for Payer: UMR Bronson Commercial |
$40.98
|
| Rate for Payer: UMR Bronson Commercial |
$39.97
|
| Rate for Payer: UMR Bronson Commercial |
$28.75
|
| Rate for Payer: UMR Bronson Commercial |
$57.78
|
| Rate for Payer: UMR Bronson Commercial |
$27.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.86
|
|
|
FRACTURE NASAL INFERIOR TURBINATE(S), THERAPEUTIC
|
Facility
|
OP
|
$9,009.23
|
|
|
Service Code
|
CPT 30930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$117.55 |
| Max. Negotiated Rate |
$9,009.23 |
| Rate for Payer: Aetna Medicare |
$2,976.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,629.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,009.23
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$7,207.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.30
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,861.84
|
| Rate for Payer: UHC Exchange |
$117.55
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
FRACTURES OF FEMUR WITH MCC
|
Facility
|
IP
|
$26,752.33
|
|
|
Service Code
|
MS-DRG 533
|
| Min. Negotiated Rate |
$12,429.77 |
| Max. Negotiated Rate |
$26,752.33 |
| Rate for Payer: Aetna Medicare |
$13,607.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,354.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,354.96
|
| Rate for Payer: BCBS MAPPO |
$13,083.97
|
| Rate for Payer: BCBS Trust/PPO |
$26,752.33
|
| Rate for Payer: BCN Medicare Advantage |
$13,083.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,083.97
|
| Rate for Payer: Mclaren Medicare |
$13,083.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,738.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,046.57
|
| Rate for Payer: PACE Medicare |
$12,429.77
|
| Rate for Payer: PACE SWMI |
$13,083.97
|
| Rate for Payer: PHP Medicare Advantage |
$13,083.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,410.46
|
| Rate for Payer: Priority Health Medicare |
$13,083.97
|
| Rate for Payer: Priority Health Narrow Network |
$18,728.37
|
| Rate for Payer: Railroad Medicare Medicare |
$13,083.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,885.38
|
| Rate for Payer: UHC Core |
$20,405.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,083.97
|
| Rate for Payer: UHC Exchange |
$16,222.64
|
| Rate for Payer: UHC Medicare Advantage |
$13,476.49
|
| Rate for Payer: VA VA |
$13,083.97
|
|
|
FRACTURES OF FEMUR WITHOUT MCC
|
Facility
|
IP
|
$14,951.76
|
|
|
Service Code
|
MS-DRG 534
|
| Min. Negotiated Rate |
$6,416.53 |
| Max. Negotiated Rate |
$14,951.76 |
| Rate for Payer: Aetna Medicare |
$7,024.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,442.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,442.80
|
| Rate for Payer: BCBS MAPPO |
$6,754.24
|
| Rate for Payer: BCBS Trust/PPO |
$14,951.76
|
| Rate for Payer: BCN Medicare Advantage |
$6,754.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,754.24
|
| Rate for Payer: Mclaren Medicare |
$6,754.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,091.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,767.38
|
| Rate for Payer: PACE Medicare |
$6,416.53
|
| Rate for Payer: PACE SWMI |
$6,754.24
|
| Rate for Payer: PHP Medicare Advantage |
$6,754.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,623.44
|
| Rate for Payer: Priority Health Medicare |
$6,754.24
|
| Rate for Payer: Priority Health Narrow Network |
$9,298.75
|
| Rate for Payer: Railroad Medicare Medicare |
$6,754.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,355.74
|
| Rate for Payer: UHC Core |
$10,131.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,754.24
|
| Rate for Payer: UHC Exchange |
$8,054.64
|
| Rate for Payer: UHC Medicare Advantage |
$6,956.87
|
| Rate for Payer: VA VA |
$6,754.24
|
|
|
FRACTURES OF HIP AND PELVIS WITH MCC
|
Facility
|
IP
|
$20,801.79
|
|
|
Service Code
|
MS-DRG 535
|
| Min. Negotiated Rate |
$9,979.53 |
| Max. Negotiated Rate |
$20,801.79 |
| Rate for Payer: Aetna Medicare |
$10,924.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,130.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,130.96
|
| Rate for Payer: BCBS MAPPO |
$10,504.77
|
| Rate for Payer: BCBS Trust/PPO |
$20,801.79
|
| Rate for Payer: BCN Medicare Advantage |
$10,504.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,504.77
|
| Rate for Payer: Mclaren Medicare |
$10,504.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,030.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,080.49
|
| Rate for Payer: PACE Medicare |
$9,979.53
|
| Rate for Payer: PACE SWMI |
$10,504.77
|
| Rate for Payer: PHP Medicare Advantage |
$10,504.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,607.54
|
| Rate for Payer: Priority Health Medicare |
$10,504.77
|
| Rate for Payer: Priority Health Narrow Network |
$14,886.03
|
| Rate for Payer: Railroad Medicare Medicare |
$10,504.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,779.86
|
| Rate for Payer: UHC Core |
$16,219.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,504.77
|
| Rate for Payer: UHC Exchange |
$12,894.38
|
| Rate for Payer: UHC Medicare Advantage |
$10,819.91
|
| Rate for Payer: VA VA |
$10,504.77
|
|
|
FRACTURES OF HIP AND PELVIS WITHOUT MCC
|
Facility
|
IP
|
$12,627.32
|
|
|
Service Code
|
MS-DRG 536
|
| Min. Negotiated Rate |
$6,248.87 |
| Max. Negotiated Rate |
$12,627.32 |
| Rate for Payer: Aetna Medicare |
$6,840.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,222.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,222.20
|
| Rate for Payer: BCBS MAPPO |
$6,577.76
|
| Rate for Payer: BCBS Trust/PPO |
$12,627.32
|
| Rate for Payer: BCN Medicare Advantage |
$6,577.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,577.76
|
| Rate for Payer: Mclaren Medicare |
$6,577.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,906.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,564.42
|
| Rate for Payer: PACE Medicare |
$6,248.87
|
| Rate for Payer: PACE SWMI |
$6,577.76
|
| Rate for Payer: PHP Medicare Advantage |
$6,577.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,294.82
|
| Rate for Payer: Priority Health Medicare |
$6,577.76
|
| Rate for Payer: Priority Health Narrow Network |
$9,035.86
|
| Rate for Payer: Railroad Medicare Medicare |
$6,577.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,006.42
|
| Rate for Payer: UHC Core |
$9,845.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,577.76
|
| Rate for Payer: UHC Exchange |
$7,826.92
|
| Rate for Payer: UHC Medicare Advantage |
$6,775.09
|
| Rate for Payer: VA VA |
$6,577.76
|
|
|
FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC
|
Facility
|
IP
|
$23,196.76
|
|
|
Service Code
|
MS-DRG 562
|
| Min. Negotiated Rate |
$11,619.37 |
| Max. Negotiated Rate |
$23,196.76 |
| Rate for Payer: Aetna Medicare |
$12,720.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,288.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,288.65
|
| Rate for Payer: BCBS MAPPO |
$12,230.92
|
| Rate for Payer: BCBS Trust/PPO |
$23,020.68
|
| Rate for Payer: BCN Medicare Advantage |
$12,230.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,230.92
|
| Rate for Payer: Mclaren Medicare |
$12,230.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,842.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,065.56
|
| Rate for Payer: PACE Medicare |
$11,619.37
|
| Rate for Payer: PACE SWMI |
$12,230.92
|
| Rate for Payer: PHP Medicare Advantage |
$12,230.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,821.92
|
| Rate for Payer: Priority Health Medicare |
$12,230.92
|
| Rate for Payer: Priority Health Narrow Network |
$17,457.54
|
| Rate for Payer: Railroad Medicare Medicare |
$12,230.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,196.76
|
| Rate for Payer: UHC Core |
$19,020.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,230.92
|
| Rate for Payer: UHC Exchange |
$15,121.84
|
| Rate for Payer: UHC Medicare Advantage |
$12,597.85
|
| Rate for Payer: VA VA |
$12,230.92
|
|
|
FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC
|
Facility
|
IP
|
$17,502.35
|
|
|
Service Code
|
MS-DRG 563
|
| Min. Negotiated Rate |
$7,043.19 |
| Max. Negotiated Rate |
$17,502.35 |
| Rate for Payer: Aetna Medicare |
$7,710.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,267.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,267.35
|
| Rate for Payer: BCBS MAPPO |
$7,413.88
|
| Rate for Payer: BCBS Trust/PPO |
$17,502.35
|
| Rate for Payer: BCN Medicare Advantage |
$7,413.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,413.88
|
| Rate for Payer: Mclaren Medicare |
$7,413.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,784.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,525.96
|
| Rate for Payer: PACE Medicare |
$7,043.19
|
| Rate for Payer: PACE SWMI |
$7,413.88
|
| Rate for Payer: PHP Medicare Advantage |
$7,413.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,851.79
|
| Rate for Payer: Priority Health Medicare |
$7,413.88
|
| Rate for Payer: Priority Health Narrow Network |
$10,281.43
|
| Rate for Payer: Railroad Medicare Medicare |
$7,413.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,661.48
|
| Rate for Payer: UHC Core |
$11,202.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,413.88
|
| Rate for Payer: UHC Exchange |
$8,905.85
|
| Rate for Payer: UHC Medicare Advantage |
$7,636.30
|
| Rate for Payer: VA VA |
$7,413.88
|
|
|
FRAXEL ARMS - BILATERAL
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 00166
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Complete |
$400.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.00
|
| Rate for Payer: UMR Bronson Commercial |
$460.00
|
|
|
FRAXEL CHEST
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 00155
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$320.00 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: BCBS Complete |
$320.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.00
|
| Rate for Payer: UMR Bronson Commercial |
$368.00
|
|
|
FRAXEL FACE & NECK
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 00162
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Complete |
$400.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.00
|
| Rate for Payer: UMR Bronson Commercial |
$460.00
|
|
|
FRAXEL FULL FACE
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 00152
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: BCBS Complete |
$240.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
| Rate for Payer: UMR Bronson Commercial |
$276.00
|
|
|
FRAXEL HANDS
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 00154
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: UMR Bronson Commercial |
$161.00
|
|
|
FRAXEL LARGE SCAR
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 00161
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$320.00 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: BCBS Complete |
$320.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.00
|
| Rate for Payer: UMR Bronson Commercial |
$368.00
|
|
|
FRAXEL MEDIUM SCAR
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 00160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: UMR Bronson Commercial |
$138.00
|
|
