|
FOOT PROCEDURES WITH MCC
|
Facility
|
IP
|
$38,346.36
|
|
|
Service Code
|
MSDRG 503
|
| Min. Negotiated Rate |
$20,761.17 |
| Max. Negotiated Rate |
$38,346.36 |
| Rate for Payer: Aetna Medicare |
$21,853.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,317.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,317.33
|
| Rate for Payer: BCBS MAPPO |
$21,853.86
|
| Rate for Payer: BCN Medicare Advantage |
$21,853.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,853.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$21,853.86
|
| Rate for Payer: Mclaren Medicare |
$21,853.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,946.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,131.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$24,039.25
|
| Rate for Payer: PACE Medicare |
$20,761.17
|
| Rate for Payer: PACE SWMI |
$21,853.86
|
| Rate for Payer: PHP Commercial |
$24,039.25
|
| Rate for Payer: PHP Medicare Advantage |
$21,853.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$38,346.36
|
| Rate for Payer: Priority Health Medicare |
$21,853.86
|
| Rate for Payer: Priority Health Narrow Network |
$30,677.09
|
| Rate for Payer: Railroad Medicare Medicare |
$21,853.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21,853.86
|
| Rate for Payer: UHC Exchange |
$33,873.48
|
| Rate for Payer: UHCCP DNSP |
$21,853.86
|
| Rate for Payer: VA VA |
$21,853.86
|
|
|
FOOT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$24,630.92
|
|
|
Service Code
|
MSDRG 505
|
| Min. Negotiated Rate |
$13,931.61 |
| Max. Negotiated Rate |
$24,630.92 |
| Rate for Payer: Aetna Medicare |
$14,664.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,331.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,331.06
|
| Rate for Payer: BCBS MAPPO |
$14,664.85
|
| Rate for Payer: BCN Medicare Advantage |
$14,664.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,664.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,664.85
|
| Rate for Payer: Mclaren Medicare |
$14,664.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,398.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,864.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,131.33
|
| Rate for Payer: PACE Medicare |
$13,931.61
|
| Rate for Payer: PACE SWMI |
$14,664.85
|
| Rate for Payer: PHP Commercial |
$16,131.33
|
| Rate for Payer: PHP Medicare Advantage |
$14,664.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$24,630.92
|
| Rate for Payer: Priority Health Medicare |
$14,664.85
|
| Rate for Payer: Priority Health Narrow Network |
$19,704.74
|
| Rate for Payer: Railroad Medicare Medicare |
$14,664.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,664.85
|
| Rate for Payer: UHC Exchange |
$22,730.52
|
| Rate for Payer: UHCCP DNSP |
$14,664.85
|
| Rate for Payer: VA VA |
$14,664.85
|
|
|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$293.15
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
106783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$293.15 |
| Rate for Payer: Aetna Commercial |
$263.83
|
| Rate for Payer: Aetna Commercial |
$257.38
|
| Rate for Payer: Aetna Medicare |
$105.81
|
| Rate for Payer: Aetna Medicare |
$108.47
|
| Rate for Payer: ASR ASR |
$284.36
|
| Rate for Payer: ASR ASR |
$277.40
|
| Rate for Payer: BCBS Complete |
$114.39
|
| Rate for Payer: BCBS Complete |
$117.26
|
| Rate for Payer: BCBS Trust/PPO |
$241.70
|
| Rate for Payer: BCBS Trust/PPO |
$235.79
|
| Rate for Payer: BCN Commercial |
$235.79
|
| Rate for Payer: BCN Commercial |
$241.70
|
| Rate for Payer: Cash Price |
$234.52
|
| Rate for Payer: Cash Price |
$228.78
|
| Rate for Payer: Cash Price |
$234.52
|
| Rate for Payer: Cash Price |
$228.78
|
| Rate for Payer: Cofinity Commercial |
$268.82
|
| Rate for Payer: Cofinity Commercial |
$275.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.78
|
| Rate for Payer: Healthscope Commercial |
$284.36
|
| Rate for Payer: Healthscope Commercial |
$277.40
|
| Rate for Payer: Healthscope Whirlpool |
$293.15
|
| Rate for Payer: Healthscope Whirlpool |
$285.98
|
| Rate for Payer: Mclaren Commercial |
$263.83
|
| Rate for Payer: Mclaren Commercial |
$257.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.18
|
| Rate for Payer: Nomi Health Commercial |
$234.50
|
| Rate for Payer: Nomi Health Commercial |
$240.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.11
|
| Rate for Payer: Priority Health Narrow Network |
$0.09
|
| Rate for Payer: Priority Health Narrow Network |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.97
|
|
|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$285.98
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
106783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$214.48 |
| Max. Negotiated Rate |
$285.98 |
| Rate for Payer: Aetna Commercial |
$257.38
|
| Rate for Payer: Aetna Commercial |
$263.83
|
| Rate for Payer: ASR ASR |
$284.36
|
| Rate for Payer: ASR ASR |
$277.40
|
| Rate for Payer: BCBS Trust/PPO |
$240.73
|
| Rate for Payer: BCBS Trust/PPO |
$234.84
|
| Rate for Payer: BCN Commercial |
$240.73
|
| Rate for Payer: BCN Commercial |
$234.84
|
| Rate for Payer: Cash Price |
$234.52
|
| Rate for Payer: Cash Price |
$228.78
|
| Rate for Payer: Cofinity Commercial |
$268.82
|
| Rate for Payer: Cofinity Commercial |
$275.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.78
|
| Rate for Payer: Healthscope Commercial |
$277.40
|
| Rate for Payer: Healthscope Commercial |
$284.36
|
| Rate for Payer: Healthscope Whirlpool |
$293.15
|
| Rate for Payer: Healthscope Whirlpool |
$285.98
|
| Rate for Payer: Mclaren Commercial |
$263.83
|
| Rate for Payer: Mclaren Commercial |
$257.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.08
|
| Rate for Payer: Nomi Health Commercial |
$240.38
|
| Rate for Payer: Nomi Health Commercial |
$234.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.97
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$203.94
|
|
|
Service Code
|
NDC 67877074957
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$203.94 |
| Rate for Payer: Aetna Commercial |
$183.55
|
| Rate for Payer: Aetna Medicare |
$75.46
|
| Rate for Payer: ASR ASR |
$197.83
|
| Rate for Payer: BCBS Complete |
$81.58
|
| Rate for Payer: BCBS Trust/PPO |
$168.15
|
| Rate for Payer: BCN Commercial |
$168.15
|
| Rate for Payer: Cash Price |
$163.16
|
| Rate for Payer: Cofinity Commercial |
$191.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.16
|
| Rate for Payer: Healthscope Commercial |
$197.83
|
| Rate for Payer: Healthscope Whirlpool |
$203.94
|
| Rate for Payer: Mclaren Commercial |
$183.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.35
|
| Rate for Payer: Nomi Health Commercial |
$167.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$178.70
|
| Rate for Payer: Priority Health Narrow Network |
$142.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.47
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$206.46
|
|
|
Service Code
|
NDC 82036427401
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.84 |
| Max. Negotiated Rate |
$206.46 |
| Rate for Payer: Aetna Commercial |
$185.81
|
| Rate for Payer: ASR ASR |
$200.27
|
| Rate for Payer: BCBS Trust/PPO |
$169.54
|
| Rate for Payer: BCN Commercial |
$169.54
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$194.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$200.27
|
| Rate for Payer: Healthscope Whirlpool |
$206.46
|
| Rate for Payer: Mclaren Commercial |
$185.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Nomi Health Commercial |
$169.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.68
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$194.25
|
|
|
Service Code
|
NDC 70700026899
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.69 |
| Max. Negotiated Rate |
$194.25 |
| Rate for Payer: Aetna Commercial |
$174.82
|
| Rate for Payer: ASR ASR |
$188.42
|
| Rate for Payer: BCBS Trust/PPO |
$159.52
|
| Rate for Payer: BCN Commercial |
$159.52
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Commercial |
$182.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Healthscope Commercial |
$188.42
|
| Rate for Payer: Healthscope Whirlpool |
$194.25
|
| Rate for Payer: Mclaren Commercial |
$174.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: Nomi Health Commercial |
$159.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.94
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$206.46
|
|
|
Service Code
|
NDC 82036427408
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.84 |
| Max. Negotiated Rate |
$206.46 |
| Rate for Payer: Aetna Commercial |
$185.81
|
| Rate for Payer: ASR ASR |
$200.27
|
| Rate for Payer: BCBS Trust/PPO |
$169.54
|
| Rate for Payer: BCN Commercial |
$169.54
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$194.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$200.27
|
| Rate for Payer: Healthscope Whirlpool |
$206.46
|
| Rate for Payer: Mclaren Commercial |
$185.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Nomi Health Commercial |
$169.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.68
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$203.94
|
|
|
Service Code
|
NDC 67877074957
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.96 |
| Max. Negotiated Rate |
$203.94 |
| Rate for Payer: Aetna Commercial |
$183.55
|
| Rate for Payer: ASR ASR |
$197.83
|
| Rate for Payer: BCBS Trust/PPO |
$167.48
|
| Rate for Payer: BCN Commercial |
$167.48
|
| Rate for Payer: Cash Price |
$163.16
|
| Rate for Payer: Cofinity Commercial |
$191.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.16
|
| Rate for Payer: Healthscope Commercial |
$197.83
|
| Rate for Payer: Healthscope Whirlpool |
$203.94
|
| Rate for Payer: Mclaren Commercial |
$183.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.35
|
| Rate for Payer: Nomi Health Commercial |
$167.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.47
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$206.46
|
|
|
Service Code
|
NDC 82036427401
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.39 |
| Max. Negotiated Rate |
$206.46 |
| Rate for Payer: Aetna Commercial |
$185.81
|
| Rate for Payer: Aetna Medicare |
$76.39
|
| Rate for Payer: ASR ASR |
$200.27
|
| Rate for Payer: BCBS Complete |
$82.58
|
| Rate for Payer: BCBS Trust/PPO |
$170.23
|
| Rate for Payer: BCN Commercial |
$170.23
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$194.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$200.27
|
| Rate for Payer: Healthscope Whirlpool |
$206.46
|
| Rate for Payer: Mclaren Commercial |
$185.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Nomi Health Commercial |
$169.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$180.90
|
| Rate for Payer: Priority Health Narrow Network |
$144.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.68
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$194.25
|
|
|
Service Code
|
NDC 70700026899
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.87 |
| Max. Negotiated Rate |
$194.25 |
| Rate for Payer: Aetna Commercial |
$174.82
|
| Rate for Payer: Aetna Medicare |
$71.87
|
| Rate for Payer: ASR ASR |
$188.42
|
| Rate for Payer: BCBS Complete |
$77.70
|
| Rate for Payer: BCBS Trust/PPO |
$160.16
|
| Rate for Payer: BCN Commercial |
$160.16
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Commercial |
$182.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Healthscope Commercial |
$188.42
|
| Rate for Payer: Healthscope Whirlpool |
$194.25
|
| Rate for Payer: Mclaren Commercial |
$174.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: Nomi Health Commercial |
$159.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$170.20
|
| Rate for Payer: Priority Health Narrow Network |
$136.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.94
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$85.84
|
|
|
Service Code
|
NDC 69097057967
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.38 |
| Max. Negotiated Rate |
$85.84 |
| Rate for Payer: Aetna Commercial |
$77.26
|
| Rate for Payer: ASR ASR |
$83.26
|
| Rate for Payer: BCBS Trust/PPO |
$70.49
|
| Rate for Payer: BCN Commercial |
$70.49
|
| Rate for Payer: Cash Price |
$68.67
|
| Rate for Payer: Cofinity Commercial |
$80.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.67
|
| Rate for Payer: Healthscope Commercial |
$83.26
|
| Rate for Payer: Healthscope Whirlpool |
$85.84
|
| Rate for Payer: Mclaren Commercial |
$77.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.96
|
| Rate for Payer: Nomi Health Commercial |
$70.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.54
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$206.46
|
|
|
Service Code
|
NDC 82036427408
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.39 |
| Max. Negotiated Rate |
$206.46 |
| Rate for Payer: Aetna Commercial |
$185.81
|
| Rate for Payer: Aetna Medicare |
$76.39
|
| Rate for Payer: ASR ASR |
$200.27
|
| Rate for Payer: BCBS Complete |
$82.58
|
| Rate for Payer: BCBS Trust/PPO |
$170.23
|
| Rate for Payer: BCN Commercial |
$170.23
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$194.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$200.27
|
| Rate for Payer: Healthscope Whirlpool |
$206.46
|
| Rate for Payer: Mclaren Commercial |
$185.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Nomi Health Commercial |
$169.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$180.90
|
| Rate for Payer: Priority Health Narrow Network |
$144.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.68
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$85.84
|
|
|
Service Code
|
NDC 69097057967
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.76 |
| Max. Negotiated Rate |
$85.84 |
| Rate for Payer: Aetna Commercial |
$77.26
|
| Rate for Payer: Aetna Medicare |
$31.76
|
| Rate for Payer: ASR ASR |
$83.26
|
| Rate for Payer: BCBS Complete |
$34.34
|
| Rate for Payer: BCBS Trust/PPO |
$70.78
|
| Rate for Payer: BCN Commercial |
$70.78
|
| Rate for Payer: Cash Price |
$68.67
|
| Rate for Payer: Cofinity Commercial |
$80.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.67
|
| Rate for Payer: Healthscope Commercial |
$83.26
|
| Rate for Payer: Healthscope Whirlpool |
$85.84
|
| Rate for Payer: Mclaren Commercial |
$77.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.96
|
| Rate for Payer: Nomi Health Commercial |
$70.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$75.21
|
| Rate for Payer: Priority Health Narrow Network |
$60.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.54
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$194.25
|
|
|
Service Code
|
NDC 70700026894
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.69 |
| Max. Negotiated Rate |
$194.25 |
| Rate for Payer: Aetna Commercial |
$174.82
|
| Rate for Payer: ASR ASR |
$188.42
|
| Rate for Payer: BCBS Trust/PPO |
$159.52
|
| Rate for Payer: BCN Commercial |
$159.52
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Commercial |
$182.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Healthscope Commercial |
$188.42
|
| Rate for Payer: Healthscope Whirlpool |
$194.25
|
| Rate for Payer: Mclaren Commercial |
$174.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: Nomi Health Commercial |
$159.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.94
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$194.25
|
|
|
Service Code
|
NDC 70700026894
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.87 |
| Max. Negotiated Rate |
$194.25 |
| Rate for Payer: Aetna Commercial |
$174.82
|
| Rate for Payer: Aetna Medicare |
$71.87
|
| Rate for Payer: ASR ASR |
$188.42
|
| Rate for Payer: BCBS Complete |
$77.70
|
| Rate for Payer: BCBS Trust/PPO |
$160.16
|
| Rate for Payer: BCN Commercial |
$160.16
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Commercial |
$182.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Healthscope Commercial |
$188.42
|
| Rate for Payer: Healthscope Whirlpool |
$194.25
|
| Rate for Payer: Mclaren Commercial |
$174.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: Nomi Health Commercial |
$159.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$170.20
|
| Rate for Payer: Priority Health Narrow Network |
$136.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.94
|
|
|
FOSINOPRIL 10 MG TABLET
|
Facility
|
IP
|
$228.42
|
|
|
Service Code
|
NDC 69097085605
|
| Hospital Charge Code |
10094
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.31 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$205.58
|
| Rate for Payer: ASR ASR |
$221.57
|
| Rate for Payer: BCBS Trust/PPO |
$187.58
|
| Rate for Payer: BCN Commercial |
$187.58
|
| Rate for Payer: Cash Price |
$182.74
|
| Rate for Payer: Cofinity Commercial |
$214.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.74
|
| Rate for Payer: Healthscope Commercial |
$221.57
|
| Rate for Payer: Healthscope Whirlpool |
$228.42
|
| Rate for Payer: Mclaren Commercial |
$205.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.16
|
| Rate for Payer: Nomi Health Commercial |
$187.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.01
|
|
|
FOSINOPRIL 10 MG TABLET
|
Facility
|
OP
|
$228.42
|
|
|
Service Code
|
NDC 69097085605
|
| Hospital Charge Code |
10094
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.52 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$205.58
|
| Rate for Payer: Aetna Medicare |
$84.52
|
| Rate for Payer: ASR ASR |
$221.57
|
| Rate for Payer: BCBS Complete |
$91.37
|
| Rate for Payer: BCBS Trust/PPO |
$188.33
|
| Rate for Payer: BCN Commercial |
$188.33
|
| Rate for Payer: Cash Price |
$182.74
|
| Rate for Payer: Cofinity Commercial |
$214.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.74
|
| Rate for Payer: Healthscope Commercial |
$221.57
|
| Rate for Payer: Healthscope Whirlpool |
$228.42
|
| Rate for Payer: Mclaren Commercial |
$205.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.16
|
| Rate for Payer: Nomi Health Commercial |
$187.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$200.14
|
| Rate for Payer: Priority Health Narrow Network |
$160.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.01
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$4,246.25
|
|
|
Service Code
|
APR-DRG 3402
|
| Min. Negotiated Rate |
$3,839.12 |
| Max. Negotiated Rate |
$4,246.25 |
| Rate for Payer: BCBS Complete |
$4,246.25
|
| Rate for Payer: Mclaren Medicaid |
$4,044.05
|
| Rate for Payer: Meridian Medicaid |
$4,246.25
|
| Rate for Payer: PHP Medicaid |
$3,839.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,044.05
|
| Rate for Payer: UHC Medicaid |
$4,044.05
|
| Rate for Payer: UHCCP Medicaid |
$4,044.05
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$11,621.60
|
|
|
Service Code
|
APR-DRG 3404
|
| Min. Negotiated Rate |
$10,507.32 |
| Max. Negotiated Rate |
$11,621.60 |
| Rate for Payer: BCBS Complete |
$11,621.60
|
| Rate for Payer: Mclaren Medicaid |
$11,068.19
|
| Rate for Payer: Meridian Medicaid |
$11,621.60
|
| Rate for Payer: PHP Medicaid |
$10,507.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,068.19
|
| Rate for Payer: UHC Medicaid |
$11,068.19
|
| Rate for Payer: UHCCP Medicaid |
$11,068.19
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$3,287.68
|
|
|
Service Code
|
APR-DRG 3401
|
| Min. Negotiated Rate |
$2,972.46 |
| Max. Negotiated Rate |
$3,287.68 |
| Rate for Payer: BCBS Complete |
$3,287.68
|
| Rate for Payer: Mclaren Medicaid |
$3,131.13
|
| Rate for Payer: Meridian Medicaid |
$3,287.68
|
| Rate for Payer: PHP Medicaid |
$2,972.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,131.13
|
| Rate for Payer: UHC Medicaid |
$3,131.13
|
| Rate for Payer: UHCCP Medicaid |
$3,131.13
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$7,794.96
|
|
|
Service Code
|
APR-DRG 3403
|
| Min. Negotiated Rate |
$7,047.58 |
| Max. Negotiated Rate |
$7,794.96 |
| Rate for Payer: BCBS Complete |
$7,794.96
|
| Rate for Payer: Mclaren Medicaid |
$7,423.78
|
| Rate for Payer: Meridian Medicaid |
$7,794.96
|
| Rate for Payer: PHP Medicaid |
$7,047.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,423.78
|
| Rate for Payer: UHC Medicaid |
$7,423.78
|
| Rate for Payer: UHCCP Medicaid |
$7,423.78
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$9,393.85
|
|
|
Service Code
|
APR-DRG 3413
|
| Min. Negotiated Rate |
$8,493.16 |
| Max. Negotiated Rate |
$9,393.85 |
| Rate for Payer: BCBS Complete |
$9,393.85
|
| Rate for Payer: Mclaren Medicaid |
$8,946.52
|
| Rate for Payer: Meridian Medicaid |
$9,393.85
|
| Rate for Payer: PHP Medicaid |
$8,493.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,946.52
|
| Rate for Payer: UHC Medicaid |
$8,946.52
|
| Rate for Payer: UHCCP Medicaid |
$8,946.52
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$3,088.23
|
|
|
Service Code
|
APR-DRG 3411
|
| Min. Negotiated Rate |
$2,792.13 |
| Max. Negotiated Rate |
$3,088.23 |
| Rate for Payer: BCBS Complete |
$3,088.23
|
| Rate for Payer: Mclaren Medicaid |
$2,941.17
|
| Rate for Payer: Meridian Medicaid |
$3,088.23
|
| Rate for Payer: PHP Medicaid |
$2,792.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,941.17
|
| Rate for Payer: UHC Medicaid |
$2,941.17
|
| Rate for Payer: UHCCP Medicaid |
$2,941.17
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$4,380.85
|
|
|
Service Code
|
APR-DRG 3412
|
| Min. Negotiated Rate |
$3,960.82 |
| Max. Negotiated Rate |
$4,380.85 |
| Rate for Payer: BCBS Complete |
$4,380.85
|
| Rate for Payer: Mclaren Medicaid |
$4,172.24
|
| Rate for Payer: Meridian Medicaid |
$4,380.85
|
| Rate for Payer: PHP Medicaid |
$3,960.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,172.24
|
| Rate for Payer: UHC Medicaid |
$4,172.24
|
| Rate for Payer: UHCCP Medicaid |
$4,172.24
|
|
