|
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 |
$9.97 |
| Max. Negotiated Rate |
$20.39 |
| Rate for Payer: Aetna American Axle |
$14.72
|
| Rate for Payer: Aetna American Axle |
$13.68
|
| Rate for Payer: Aetna American Axle |
$18.23
|
| Rate for Payer: Aetna American Axle |
$108.76
|
| Rate for Payer: Aetna American Axle |
$9.85
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$17.89
|
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Aetna Commercial |
$23.84
|
| Rate for Payer: Aetna Commercial |
$142.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.23
|
| Rate for Payer: Cash Price |
$16.84
|
| Rate for Payer: Cash Price |
$133.86
|
| Rate for Payer: Cash Price |
$22.44
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cofinity Advantage |
$10.61
|
| Rate for Payer: Cofinity Advantage |
$19.64
|
| Rate for Payer: Cofinity Advantage |
$117.12
|
| Rate for Payer: Cofinity Advantage |
$15.86
|
| Rate for Payer: Cofinity Advantage |
$14.73
|
| Rate for Payer: Cofinity Commercial |
$24.12
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$143.90
|
| Rate for Payer: Cofinity Commercial |
$18.10
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.44
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$150.59
|
| Rate for Payer: Healthscope Commercial |
$18.95
|
| Rate for Payer: Healthscope Commercial |
$20.39
|
| Rate for Payer: Healthscope Commercial |
$25.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.99
|
| Rate for Payer: PHP Commercial |
$17.89
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$19.25
|
| Rate for Payer: PHP Commercial |
$23.84
|
| Rate for Payer: PHP Commercial |
$142.22
|
| Rate for Payer: Priority Health SBD |
$14.27
|
| Rate for Payer: Priority Health SBD |
$17.67
|
| Rate for Payer: Priority Health SBD |
$105.41
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: Priority Health SBD |
$13.26
|
| Rate for Payer: UMR Bronson Commercial |
$73.62
|
| Rate for Payer: UMR Bronson Commercial |
$12.34
|
| Rate for Payer: UMR Bronson Commercial |
$9.26
|
| Rate for Payer: UMR Bronson Commercial |
$6.67
|
| Rate for Payer: UMR Bronson Commercial |
$9.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.49
|
|
|
FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION
|
Facility
|
OP
|
$15.15
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
17764
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$13.63 |
| Rate for Payer: Aetna American Axle |
$9.85
|
| Rate for Payer: Aetna American Axle |
$13.68
|
| Rate for Payer: Aetna American Axle |
$18.23
|
| Rate for Payer: Aetna American Axle |
$14.72
|
| Rate for Payer: Aetna American Axle |
$108.76
|
| Rate for Payer: Aetna Commercial |
$23.84
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$17.89
|
| Rate for Payer: Aetna Commercial |
$142.22
|
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$22.44
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$133.86
|
| Rate for Payer: Cash Price |
$22.44
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$16.84
|
| Rate for Payer: Cash Price |
$16.84
|
| Rate for Payer: Cash Price |
$133.86
|
| Rate for Payer: Cofinity Advantage |
$10.61
|
| Rate for Payer: Cofinity Advantage |
$14.73
|
| Rate for Payer: Cofinity Advantage |
$19.64
|
| Rate for Payer: Cofinity Advantage |
$15.86
|
| Rate for Payer: Cofinity Advantage |
$117.12
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$24.12
|
| Rate for Payer: Cofinity Commercial |
$18.10
|
| Rate for Payer: Cofinity Commercial |
$143.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Healthscope Commercial |
$25.25
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$20.39
|
| Rate for Payer: Healthscope Commercial |
$18.95
|
| Rate for Payer: Healthscope Commercial |
$150.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.04
|
| Rate for Payer: Mclaren Medicaid |
$1.33
|
| Rate for Payer: Mclaren Medicaid |
$1.33
|
| Rate for Payer: Mclaren Medicaid |
$1.33
|
| Rate for Payer: Mclaren Medicaid |
$1.33
|
| Rate for Payer: Mclaren Medicaid |
$1.33
|
| Rate for Payer: Mclaren Medicare |
$1.33
|
| Rate for Payer: Mclaren Medicare |
$1.33
|
| Rate for Payer: Mclaren Medicare |
$1.33
|
| Rate for Payer: Mclaren Medicare |
$1.33
|
| Rate for Payer: Mclaren Medicare |
$1.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.40
|
| Rate for Payer: Meridian Medicaid |
$1.40
|
| Rate for Payer: Meridian Medicaid |
$1.40
|
| Rate for Payer: Meridian Medicaid |
$1.40
|
| Rate for Payer: Meridian Medicaid |
$1.40
|
| Rate for Payer: Meridian Medicaid |
$1.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.84
|
| Rate for Payer: Nomi Health Commercial |
$3.99
|
| Rate for Payer: Nomi Health Commercial |
$3.99
|
| Rate for Payer: Nomi Health Commercial |
$3.99
|
| Rate for Payer: Nomi Health Commercial |
$3.99
|
| Rate for Payer: Nomi Health Commercial |
$3.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.36
|
| Rate for Payer: PACE Medicare |
$1.26
|
| Rate for Payer: PACE Medicare |
$1.26
|
| Rate for Payer: PACE Medicare |
$1.26
|
| Rate for Payer: PACE Medicare |
$1.26
|
| Rate for Payer: PACE Medicare |
$1.26
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PHP Commercial |
$19.25
|
| Rate for Payer: PHP Commercial |
$17.89
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$142.22
|
| Rate for Payer: PHP Commercial |
$23.84
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.64
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health SBD |
$14.27
|
| Rate for Payer: Priority Health SBD |
$13.26
|
| Rate for Payer: Priority Health SBD |
$105.41
|
| Rate for Payer: Priority Health SBD |
$17.67
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: Priority Health Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.33
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: UMR Bronson Commercial |
$7.79
|
| Rate for Payer: UMR Bronson Commercial |
$10.38
|
| Rate for Payer: UMR Bronson Commercial |
$8.38
|
| Rate for Payer: UMR Bronson Commercial |
$5.61
|
| Rate for Payer: UMR Bronson Commercial |
$61.91
|
| Rate for Payer: VA VA |
$1.33
|
| Rate for Payer: VA VA |
$1.33
|
| Rate for Payer: VA VA |
$1.33
|
| Rate for Payer: VA VA |
$1.33
|
| Rate for Payer: VA VA |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.04
|
|
|
FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION
|
Facility
|
IP
|
$106.18
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
88010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.72 |
| Max. Negotiated Rate |
$95.56 |
| Rate for Payer: Aetna American Axle |
$69.02
|
| Rate for Payer: Aetna American Axle |
$32.29
|
| Rate for Payer: Aetna American Axle |
$40.21
|
| Rate for Payer: Aetna American Axle |
$59.04
|
| Rate for Payer: Aetna American Axle |
$45.50
|
| Rate for Payer: Aetna American Axle |
$42.46
|
| Rate for Payer: Aetna American Axle |
$260.29
|
| Rate for Payer: Aetna Commercial |
$52.58
|
| Rate for Payer: Aetna Commercial |
$340.37
|
| Rate for Payer: Aetna Commercial |
$90.25
|
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna Commercial |
$77.21
|
| Rate for Payer: Aetna Commercial |
$55.53
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.04
|
| Rate for Payer: Cash Price |
$84.94
|
| Rate for Payer: Cash Price |
$49.49
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$320.35
|
| Rate for Payer: Cash Price |
$52.26
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$72.66
|
| Rate for Payer: Cofinity Advantage |
$49.00
|
| Rate for Payer: Cofinity Advantage |
$74.33
|
| Rate for Payer: Cofinity Advantage |
$280.31
|
| Rate for Payer: Cofinity Advantage |
$43.30
|
| Rate for Payer: Cofinity Advantage |
$34.77
|
| Rate for Payer: Cofinity Advantage |
$45.73
|
| Rate for Payer: Cofinity Advantage |
$63.58
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$78.11
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Cofinity Commercial |
$91.31
|
| Rate for Payer: Cofinity Commercial |
$344.38
|
| Rate for Payer: Cofinity Commercial |
$56.18
|
| Rate for Payer: Cofinity Commercial |
$53.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.35
|
| Rate for Payer: Healthscope Commercial |
$81.75
|
| Rate for Payer: Healthscope Commercial |
$95.56
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Healthscope Commercial |
$55.67
|
| Rate for Payer: Healthscope Commercial |
$360.40
|
| Rate for Payer: Healthscope Commercial |
$44.70
|
| Rate for Payer: Healthscope Commercial |
$58.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.33
|
| Rate for Payer: PHP Commercial |
$340.37
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: PHP Commercial |
$52.58
|
| Rate for Payer: PHP Commercial |
$77.21
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: PHP Commercial |
$90.25
|
| Rate for Payer: PHP Commercial |
$55.53
|
| Rate for Payer: Priority Health SBD |
$66.89
|
| Rate for Payer: Priority Health SBD |
$38.97
|
| Rate for Payer: Priority Health SBD |
$41.16
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: Priority Health SBD |
$57.22
|
| Rate for Payer: Priority Health SBD |
$252.28
|
| Rate for Payer: Priority Health SBD |
$31.29
|
| Rate for Payer: UMR Bronson Commercial |
$39.97
|
| Rate for Payer: UMR Bronson Commercial |
$46.72
|
| Rate for Payer: UMR Bronson Commercial |
$27.22
|
| Rate for Payer: UMR Bronson Commercial |
$176.19
|
| Rate for Payer: UMR Bronson Commercial |
$28.75
|
| Rate for Payer: UMR Bronson Commercial |
$30.80
|
| Rate for Payer: UMR Bronson Commercial |
$21.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.64
|
| 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 |
$52.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.12
|
|
|
FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION
|
Facility
|
OP
|
$90.83
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
88010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$81.75 |
| Rate for Payer: Aetna American Axle |
$59.04
|
| Rate for Payer: Aetna American Axle |
$45.50
|
| Rate for Payer: Aetna American Axle |
$260.29
|
| Rate for Payer: Aetna American Axle |
$42.46
|
| Rate for Payer: Aetna American Axle |
$69.02
|
| Rate for Payer: Aetna American Axle |
$40.21
|
| Rate for Payer: Aetna American Axle |
$32.29
|
| Rate for Payer: Aetna Commercial |
$55.53
|
| Rate for Payer: Aetna Commercial |
$90.25
|
| Rate for Payer: Aetna Commercial |
$77.21
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna Commercial |
$340.37
|
| Rate for Payer: Aetna Commercial |
$52.58
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Commercial |
$1.02
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: Cash Price |
$72.66
|
| Rate for Payer: Cash Price |
$49.49
|
| Rate for Payer: Cash Price |
$84.94
|
| Rate for Payer: Cash Price |
$52.26
|
| Rate for Payer: Cash Price |
$84.94
|
| Rate for Payer: Cash Price |
$52.26
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$320.35
|
| Rate for Payer: Cash Price |
$72.66
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$320.35
|
| Rate for Payer: Cash Price |
$49.49
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cofinity Advantage |
$63.58
|
| Rate for Payer: Cofinity Advantage |
$45.73
|
| Rate for Payer: Cofinity Advantage |
$74.33
|
| Rate for Payer: Cofinity Advantage |
$49.00
|
| Rate for Payer: Cofinity Advantage |
$34.77
|
| Rate for Payer: Cofinity Advantage |
$43.30
|
| Rate for Payer: Cofinity Advantage |
$280.31
|
| Rate for Payer: Cofinity Commercial |
$344.38
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Cofinity Commercial |
$56.18
|
| Rate for Payer: Cofinity Commercial |
$78.11
|
| Rate for Payer: Cofinity Commercial |
$53.20
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$91.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Healthscope Commercial |
$58.80
|
| Rate for Payer: Healthscope Commercial |
$95.56
|
| Rate for Payer: Healthscope Commercial |
$81.75
|
| Rate for Payer: Healthscope Commercial |
$55.67
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Healthscope Commercial |
$44.70
|
| Rate for Payer: Healthscope Commercial |
$360.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.33
|
| Rate for Payer: Mclaren Medicaid |
$1.33
|
| Rate for Payer: Mclaren Medicaid |
$1.33
|
| Rate for Payer: Mclaren Medicaid |
$1.33
|
| Rate for Payer: Mclaren Medicaid |
$1.33
|
| Rate for Payer: Mclaren Medicaid |
$1.33
|
| Rate for Payer: Mclaren Medicaid |
$1.33
|
| Rate for Payer: Mclaren Medicaid |
$1.33
|
| Rate for Payer: Mclaren Medicare |
$1.33
|
| Rate for Payer: Mclaren Medicare |
$1.33
|
| Rate for Payer: Mclaren Medicare |
$1.33
|
| Rate for Payer: Mclaren Medicare |
$1.33
|
| Rate for Payer: Mclaren Medicare |
$1.33
|
| Rate for Payer: Mclaren Medicare |
$1.33
|
| Rate for Payer: Mclaren Medicare |
$1.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.40
|
| Rate for Payer: Meridian Medicaid |
$1.40
|
| Rate for Payer: Meridian Medicaid |
$1.40
|
| Rate for Payer: Meridian Medicaid |
$1.40
|
| Rate for Payer: Meridian Medicaid |
$1.40
|
| Rate for Payer: Meridian Medicaid |
$1.40
|
| Rate for Payer: Meridian Medicaid |
$1.40
|
| Rate for Payer: Meridian Medicaid |
$1.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.53
|
| Rate for Payer: Nomi Health Commercial |
$3.99
|
| Rate for Payer: Nomi Health Commercial |
$3.99
|
| Rate for Payer: Nomi Health Commercial |
$3.99
|
| Rate for Payer: Nomi Health Commercial |
$3.99
|
| Rate for Payer: Nomi Health Commercial |
$3.99
|
| Rate for Payer: Nomi Health Commercial |
$3.99
|
| Rate for Payer: Nomi Health Commercial |
$3.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.50
|
| Rate for Payer: PACE Medicare |
$1.26
|
| Rate for Payer: PACE Medicare |
$1.26
|
| Rate for Payer: PACE Medicare |
$1.26
|
| Rate for Payer: PACE Medicare |
$1.26
|
| Rate for Payer: PACE Medicare |
$1.26
|
| Rate for Payer: PACE Medicare |
$1.26
|
| Rate for Payer: PACE Medicare |
$1.26
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: PHP Commercial |
$55.53
|
| Rate for Payer: PHP Commercial |
$52.58
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: PHP Commercial |
$340.37
|
| Rate for Payer: PHP Commercial |
$77.21
|
| Rate for Payer: PHP Commercial |
$90.25
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.64
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health SBD |
$31.29
|
| Rate for Payer: Priority Health SBD |
$57.22
|
| Rate for Payer: Priority Health SBD |
$38.97
|
| Rate for Payer: Priority Health SBD |
$252.28
|
| Rate for Payer: Priority Health SBD |
$41.16
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: Priority Health SBD |
$66.89
|
| Rate for Payer: Priority Health Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.33
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: UMR Bronson Commercial |
$25.90
|
| Rate for Payer: UMR Bronson Commercial |
$148.16
|
| Rate for Payer: UMR Bronson Commercial |
$24.17
|
| Rate for Payer: UMR Bronson Commercial |
$22.89
|
| Rate for Payer: UMR Bronson Commercial |
$18.38
|
| Rate for Payer: UMR Bronson Commercial |
$33.61
|
| Rate for Payer: UMR Bronson Commercial |
$39.29
|
| Rate for Payer: VA VA |
$1.33
|
| Rate for Payer: VA VA |
$1.33
|
| Rate for Payer: VA VA |
$1.33
|
| Rate for Payer: VA VA |
$1.33
|
| Rate for Payer: VA VA |
$1.33
|
| Rate for Payer: VA VA |
$1.33
|
| Rate for Payer: VA VA |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.12
|
|
|
FRACTURE NASAL INFERIOR TURBINATE(S), THERAPEUTIC
|
Facility
|
OP
|
$10,683.35
|
|
|
Service Code
|
CPT 30930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,727.75 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,064.42
|
| Rate for Payer: BCN Commercial |
$2,064.42
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Mclaren Medicaid |
$3,303.54
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$8,658.57
|
|
|
Service Code
|
APR-DRG 3403
|
| Min. Negotiated Rate |
$8,246.26 |
| Max. Negotiated Rate |
$8,658.57 |
| Rate for Payer: BCBS Complete |
$8,658.57
|
| Rate for Payer: Mclaren Medicaid |
$8,246.26
|
| Rate for Payer: Meridian Medicaid |
$8,658.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,246.26
|
| Rate for Payer: UHC Medicaid |
$8,246.26
|
| Rate for Payer: UHCCP Medicaid |
$8,246.26
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$3,651.93
|
|
|
Service Code
|
APR-DRG 3401
|
| Min. Negotiated Rate |
$3,478.02 |
| Max. Negotiated Rate |
$3,651.93 |
| Rate for Payer: BCBS Complete |
$3,651.93
|
| Rate for Payer: Mclaren Medicaid |
$3,478.02
|
| Rate for Payer: Meridian Medicaid |
$3,651.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.02
|
| Rate for Payer: UHC Medicaid |
$3,478.02
|
| Rate for Payer: UHCCP Medicaid |
$3,478.02
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$12,909.16
|
|
|
Service Code
|
APR-DRG 3404
|
| Min. Negotiated Rate |
$12,294.44 |
| Max. Negotiated Rate |
$12,909.16 |
| Rate for Payer: BCBS Complete |
$12,909.16
|
| Rate for Payer: Mclaren Medicaid |
$12,294.44
|
| Rate for Payer: Meridian Medicaid |
$12,909.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,294.44
|
| Rate for Payer: UHC Medicaid |
$12,294.44
|
| Rate for Payer: UHCCP Medicaid |
$12,294.44
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$4,716.69
|
|
|
Service Code
|
APR-DRG 3402
|
| Min. Negotiated Rate |
$4,492.09 |
| Max. Negotiated Rate |
$4,716.69 |
| Rate for Payer: BCBS Complete |
$4,716.69
|
| Rate for Payer: Mclaren Medicaid |
$4,492.09
|
| Rate for Payer: Meridian Medicaid |
$4,716.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,492.09
|
| Rate for Payer: UHC Medicaid |
$4,492.09
|
| Rate for Payer: UHCCP Medicaid |
$4,492.09
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$3,430.38
|
|
|
Service Code
|
APR-DRG 3411
|
| Min. Negotiated Rate |
$3,267.03 |
| Max. Negotiated Rate |
$3,430.38 |
| Rate for Payer: BCBS Complete |
$3,430.38
|
| Rate for Payer: Mclaren Medicaid |
$3,267.03
|
| Rate for Payer: Meridian Medicaid |
$3,430.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,267.03
|
| Rate for Payer: UHC Medicaid |
$3,267.03
|
| Rate for Payer: UHCCP Medicaid |
$3,267.03
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$17,975.73
|
|
|
Service Code
|
APR-DRG 3414
|
| Min. Negotiated Rate |
$17,119.74 |
| Max. Negotiated Rate |
$17,975.73 |
| Rate for Payer: BCBS Complete |
$17,975.73
|
| Rate for Payer: Mclaren Medicaid |
$17,119.74
|
| Rate for Payer: Meridian Medicaid |
$17,975.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,119.74
|
| Rate for Payer: UHC Medicaid |
$17,119.74
|
| Rate for Payer: UHCCP Medicaid |
$17,119.74
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$10,434.59
|
|
|
Service Code
|
APR-DRG 3413
|
| Min. Negotiated Rate |
$9,937.71 |
| Max. Negotiated Rate |
$10,434.59 |
| Rate for Payer: BCBS Complete |
$10,434.59
|
| Rate for Payer: Mclaren Medicaid |
$9,937.71
|
| Rate for Payer: Meridian Medicaid |
$10,434.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,937.71
|
| Rate for Payer: UHC Medicaid |
$9,937.71
|
| Rate for Payer: UHCCP Medicaid |
$9,937.71
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$4,866.21
|
|
|
Service Code
|
APR-DRG 3412
|
| Min. Negotiated Rate |
$4,634.48 |
| Max. Negotiated Rate |
$4,866.21 |
| Rate for Payer: BCBS Complete |
$4,866.21
|
| Rate for Payer: Mclaren Medicaid |
$4,634.48
|
| Rate for Payer: Meridian Medicaid |
$4,866.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,634.48
|
| Rate for Payer: UHC Medicaid |
$4,634.48
|
| Rate for Payer: UHCCP Medicaid |
$4,634.48
|
|
|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$7,966.68
|
|
|
Service Code
|
APR-DRG 3423
|
| Min. Negotiated Rate |
$7,587.32 |
| Max. Negotiated Rate |
$7,966.68 |
| Rate for Payer: BCBS Complete |
$7,966.68
|
| Rate for Payer: Mclaren Medicaid |
$7,587.32
|
| Rate for Payer: Meridian Medicaid |
$7,966.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,587.32
|
| Rate for Payer: UHC Medicaid |
$7,587.32
|
| Rate for Payer: UHCCP Medicaid |
$7,587.32
|
|
|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$5,889.81
|
|
|
Service Code
|
APR-DRG 3422
|
| Min. Negotiated Rate |
$5,609.35 |
| Max. Negotiated Rate |
$5,889.81 |
| Rate for Payer: BCBS Complete |
$5,889.81
|
| Rate for Payer: Mclaren Medicaid |
$5,609.35
|
| Rate for Payer: Meridian Medicaid |
$5,889.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,609.35
|
| Rate for Payer: UHC Medicaid |
$5,609.35
|
| Rate for Payer: UHCCP Medicaid |
$5,609.35
|
|
|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$4,846.23
|
|
|
Service Code
|
APR-DRG 3421
|
| Min. Negotiated Rate |
$4,615.46 |
| Max. Negotiated Rate |
$4,846.23 |
| Rate for Payer: BCBS Complete |
$4,846.23
|
| Rate for Payer: Mclaren Medicaid |
$4,615.46
|
| Rate for Payer: Meridian Medicaid |
$4,846.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,615.46
|
| Rate for Payer: UHC Medicaid |
$4,615.46
|
| Rate for Payer: UHCCP Medicaid |
$4,615.46
|
|
|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$14,265.69
|
|
|
Service Code
|
APR-DRG 3424
|
| Min. Negotiated Rate |
$13,586.38 |
| Max. Negotiated Rate |
$14,265.69 |
| Rate for Payer: BCBS Complete |
$14,265.69
|
| Rate for Payer: Mclaren Medicaid |
$13,586.38
|
| Rate for Payer: Meridian Medicaid |
$14,265.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,586.38
|
| Rate for Payer: UHC Medicaid |
$13,586.38
|
| Rate for Payer: UHCCP Medicaid |
$13,586.38
|
|
|
FRACTURES OF FEMUR WITH MCC
|
Facility
|
IP
|
$29,224.33
|
|
|
Service Code
|
MSDRG 533
|
| Min. Negotiated Rate |
$13,018.01 |
| Max. Negotiated Rate |
$29,224.33 |
| Rate for Payer: Aetna Medicare |
$14,251.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,128.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,128.96
|
| Rate for Payer: BCBS MAPPO |
$13,703.17
|
| Rate for Payer: BCBS Trust/PPO |
$29,224.33
|
| Rate for Payer: BCN Commercial |
$29,224.33
|
| Rate for Payer: BCN Medicare Advantage |
$13,703.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,703.17
|
| Rate for Payer: Mclaren Medicare |
$13,703.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,388.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,758.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,073.49
|
| Rate for Payer: Nomi Health Commercial |
$20,223.33
|
| Rate for Payer: PACE Medicare |
$13,018.01
|
| Rate for Payer: PACE SWMI |
$13,703.17
|
| Rate for Payer: PHP Medicare Advantage |
$13,703.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25,274.68
|
| Rate for Payer: Priority Health Medicare |
$13,703.17
|
| Rate for Payer: Priority Health Tiered Network |
$20,219.74
|
| Rate for Payer: Railroad Medicare Medicare |
$13,703.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,553.51
|
| Rate for Payer: UHC Core |
$21,378.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,703.17
|
| Rate for Payer: UHC Exchange |
$17,459.47
|
| Rate for Payer: VA VA |
$13,703.17
|
|
|
FRACTURES OF FEMUR WITHOUT MCC
|
Facility
|
IP
|
$16,333.34
|
|
|
Service Code
|
MSDRG 534
|
| Min. Negotiated Rate |
$6,967.42 |
| Max. Negotiated Rate |
$16,333.34 |
| Rate for Payer: Aetna Medicare |
$7,627.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,167.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,167.66
|
| Rate for Payer: BCBS MAPPO |
$7,334.13
|
| Rate for Payer: BCBS Trust/PPO |
$16,333.34
|
| Rate for Payer: BCN Commercial |
$16,333.34
|
| Rate for Payer: BCN Medicare Advantage |
$7,334.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,334.13
|
| Rate for Payer: Mclaren Medicare |
$7,334.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,700.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,434.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,067.54
|
| Rate for Payer: Nomi Health Commercial |
$10,398.69
|
| Rate for Payer: PACE Medicare |
$6,967.42
|
| Rate for Payer: PACE SWMI |
$7,334.13
|
| Rate for Payer: PHP Medicare Advantage |
$7,334.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,996.06
|
| Rate for Payer: Priority Health Medicare |
$7,334.13
|
| Rate for Payer: Priority Health Tiered Network |
$10,396.84
|
| Rate for Payer: Railroad Medicare Medicare |
$7,334.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,139.43
|
| Rate for Payer: UHC Core |
$10,992.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,334.13
|
| Rate for Payer: UHC Exchange |
$8,977.54
|
| Rate for Payer: VA VA |
$7,334.13
|
|
|
FRACTURES OF HIP AND PELVIS WITH MCC
|
Facility
|
IP
|
$22,723.94
|
|
|
Service Code
|
MSDRG 535
|
| Min. Negotiated Rate |
$10,748.25 |
| Max. Negotiated Rate |
$22,723.94 |
| Rate for Payer: Aetna Medicare |
$11,766.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,142.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,142.44
|
| Rate for Payer: BCBS MAPPO |
$11,313.95
|
| Rate for Payer: BCBS Trust/PPO |
$22,723.94
|
| Rate for Payer: BCN Commercial |
$22,723.94
|
| Rate for Payer: BCN Medicare Advantage |
$11,313.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,313.95
|
| Rate for Payer: Mclaren Medicare |
$11,313.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,879.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,011.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,445.34
|
| Rate for Payer: Nomi Health Commercial |
$16,537.80
|
| Rate for Payer: PACE Medicare |
$10,748.25
|
| Rate for Payer: PACE SWMI |
$11,313.95
|
| Rate for Payer: PHP Medicare Advantage |
$11,313.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,668.58
|
| Rate for Payer: Priority Health Medicare |
$11,313.95
|
| Rate for Payer: Priority Health Tiered Network |
$16,534.86
|
| Rate for Payer: Railroad Medicare Medicare |
$11,313.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,896.60
|
| Rate for Payer: UHC Core |
$17,482.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,313.95
|
| Rate for Payer: UHC Exchange |
$14,277.63
|
| Rate for Payer: VA VA |
$11,313.95
|
|
|
FRACTURES OF HIP AND PELVIS WITHOUT MCC
|
Facility
|
IP
|
$13,794.13
|
|
|
Service Code
|
MSDRG 536
|
| Min. Negotiated Rate |
$6,979.36 |
| Max. Negotiated Rate |
$13,794.13 |
| Rate for Payer: Aetna Medicare |
$7,640.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,183.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,183.38
|
| Rate for Payer: BCBS MAPPO |
$7,346.70
|
| Rate for Payer: BCBS Trust/PPO |
$13,794.13
|
| Rate for Payer: BCN Commercial |
$13,794.13
|
| Rate for Payer: BCN Medicare Advantage |
$7,346.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,346.70
|
| Rate for Payer: Mclaren Medicare |
$7,346.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,714.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,448.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,081.37
|
| Rate for Payer: Nomi Health Commercial |
$10,418.04
|
| Rate for Payer: PACE Medicare |
$6,979.36
|
| Rate for Payer: PACE SWMI |
$7,346.70
|
| Rate for Payer: PHP Medicare Advantage |
$7,346.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,020.24
|
| Rate for Payer: Priority Health Medicare |
$7,346.70
|
| Rate for Payer: Priority Health Tiered Network |
$10,416.19
|
| Rate for Payer: Railroad Medicare Medicare |
$7,346.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,163.88
|
| Rate for Payer: UHC Core |
$11,013.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,346.70
|
| Rate for Payer: UHC Exchange |
$8,994.24
|
| Rate for Payer: VA VA |
$7,346.70
|
|
|
FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC
|
Facility
|
IP
|
$25,147.86
|
|
|
Service Code
|
MSDRG 562
|
| Min. Negotiated Rate |
$11,882.73 |
| Max. Negotiated Rate |
$25,147.86 |
| Rate for Payer: Aetna Medicare |
$13,008.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,635.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,635.17
|
| Rate for Payer: BCBS MAPPO |
$12,508.14
|
| Rate for Payer: BCBS Trust/PPO |
$25,147.86
|
| Rate for Payer: BCN Commercial |
$25,147.86
|
| Rate for Payer: BCN Medicare Advantage |
$12,508.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,508.14
|
| Rate for Payer: Mclaren Medicare |
$12,508.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,133.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,384.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,758.95
|
| Rate for Payer: Nomi Health Commercial |
$18,379.92
|
| Rate for Payer: PACE Medicare |
$11,882.73
|
| Rate for Payer: PACE SWMI |
$12,508.14
|
| Rate for Payer: PHP Medicare Advantage |
$12,508.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,970.83
|
| Rate for Payer: Priority Health Medicare |
$12,508.14
|
| Rate for Payer: Priority Health Tiered Network |
$18,376.66
|
| Rate for Payer: Railroad Medicare Medicare |
$12,508.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,224.24
|
| Rate for Payer: UHC Core |
$19,430.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,508.14
|
| Rate for Payer: UHC Exchange |
$15,868.00
|
| Rate for Payer: VA VA |
$12,508.14
|
|
|
FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC
|
Facility
|
IP
|
$19,119.62
|
|
|
Service Code
|
MSDRG 563
|
| Min. Negotiated Rate |
$7,677.67 |
| Max. Negotiated Rate |
$19,119.62 |
| Rate for Payer: Aetna Medicare |
$8,405.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,102.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,102.20
|
| Rate for Payer: BCBS MAPPO |
$8,081.76
|
| Rate for Payer: BCBS Trust/PPO |
$19,119.62
|
| Rate for Payer: BCN Commercial |
$19,119.62
|
| Rate for Payer: BCN Medicare Advantage |
$8,081.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,081.76
|
| Rate for Payer: Mclaren Medicare |
$8,081.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,485.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,294.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,889.94
|
| Rate for Payer: Nomi Health Commercial |
$11,551.95
|
| Rate for Payer: PACE Medicare |
$7,677.67
|
| Rate for Payer: PACE SWMI |
$8,081.76
|
| Rate for Payer: PHP Medicare Advantage |
$8,081.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,437.38
|
| Rate for Payer: Priority Health Medicare |
$8,081.76
|
| Rate for Payer: Priority Health Tiered Network |
$11,549.90
|
| Rate for Payer: Railroad Medicare Medicare |
$8,081.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,596.65
|
| Rate for Payer: UHC Core |
$12,211.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,081.76
|
| Rate for Payer: UHC Exchange |
$9,973.18
|
| Rate for Payer: VA VA |
$8,081.76
|
|
|
FRAXEL ARMS - BILATERAL
|
Professional
|
Both
|
$1,051.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$420.40 |
| Max. Negotiated Rate |
$788.25 |
| Rate for Payer: Aetna Medicare |
$525.50
|
| Rate for Payer: BCBS Complete |
$420.40
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$788.25
|
| Rate for Payer: UMR Bronson Commercial |
$483.46
|
|
|
FRAXEL CHEST
|
Professional
|
Both
|
$840.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna Medicare |
$420.00
|
| Rate for Payer: BCBS Complete |
$336.00
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$630.00
|
| Rate for Payer: UMR Bronson Commercial |
$386.40
|
|
