|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$277.30
|
|
|
Service Code
|
NDC 63739090310
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.97 |
| Max. Negotiated Rate |
$277.30 |
| Rate for Payer: Aetna Commercial |
$249.57
|
| Rate for Payer: ASR ASR |
$268.98
|
| Rate for Payer: BCBS Trust/PPO |
$227.72
|
| Rate for Payer: BCN Commercial |
$227.72
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Commercial |
$260.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$268.98
|
| Rate for Payer: Healthscope Whirlpool |
$277.30
|
| Rate for Payer: Mclaren Commercial |
$249.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Nomi Health Commercial |
$227.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.02
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
OP
|
$366.60
|
|
|
Service Code
|
NDC 904666761
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.64 |
| Max. Negotiated Rate |
$366.60 |
| Rate for Payer: Aetna Commercial |
$329.94
|
| Rate for Payer: Aetna Medicare |
$135.64
|
| Rate for Payer: ASR ASR |
$355.60
|
| Rate for Payer: BCBS Complete |
$146.64
|
| Rate for Payer: BCBS Trust/PPO |
$302.26
|
| Rate for Payer: BCN Commercial |
$302.26
|
| Rate for Payer: Cash Price |
$293.28
|
| Rate for Payer: Cofinity Commercial |
$344.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.28
|
| Rate for Payer: Healthscope Commercial |
$355.60
|
| Rate for Payer: Healthscope Whirlpool |
$366.60
|
| Rate for Payer: Mclaren Commercial |
$329.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.61
|
| Rate for Payer: Nomi Health Commercial |
$300.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$321.21
|
| Rate for Payer: Priority Health Narrow Network |
$256.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.61
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
IP
|
$366.60
|
|
|
Service Code
|
NDC 904666761
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$274.95 |
| Max. Negotiated Rate |
$366.60 |
| Rate for Payer: Aetna Commercial |
$329.94
|
| Rate for Payer: ASR ASR |
$355.60
|
| Rate for Payer: BCBS Trust/PPO |
$301.05
|
| Rate for Payer: BCN Commercial |
$301.05
|
| Rate for Payer: Cash Price |
$293.28
|
| Rate for Payer: Cofinity Commercial |
$344.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.28
|
| Rate for Payer: Healthscope Commercial |
$355.60
|
| Rate for Payer: Healthscope Whirlpool |
$366.60
|
| Rate for Payer: Mclaren Commercial |
$329.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.61
|
| Rate for Payer: Nomi Health Commercial |
$300.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.61
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
OP
|
$239.70
|
|
|
Service Code
|
NDC 63739098410
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.69 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna Medicare |
$88.69
|
| Rate for Payer: ASR ASR |
$232.51
|
| Rate for Payer: BCBS Complete |
$95.88
|
| Rate for Payer: BCBS Trust/PPO |
$197.63
|
| Rate for Payer: BCN Commercial |
$197.63
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$225.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Healthscope Commercial |
$232.51
|
| Rate for Payer: Healthscope Whirlpool |
$239.70
|
| Rate for Payer: Mclaren Commercial |
$215.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.75
|
| Rate for Payer: Nomi Health Commercial |
$196.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$210.03
|
| Rate for Payer: Priority Health Narrow Network |
$168.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.94
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
IP
|
$239.70
|
|
|
Service Code
|
NDC 63739098410
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.78 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: ASR ASR |
$232.51
|
| Rate for Payer: BCBS Trust/PPO |
$196.84
|
| Rate for Payer: BCN Commercial |
$196.84
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$225.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Healthscope Commercial |
$232.51
|
| Rate for Payer: Healthscope Whirlpool |
$239.70
|
| Rate for Payer: Mclaren Commercial |
$215.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.75
|
| Rate for Payer: Nomi Health Commercial |
$196.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.94
|
|
|
GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$128.40
|
|
|
Service Code
|
HCPCS A9577
|
| Hospital Charge Code |
41137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$128.40 |
| Rate for Payer: Aetna Commercial |
$115.56
|
| Rate for Payer: Aetna Commercial |
$28.89
|
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna Medicare |
$11.88
|
| Rate for Payer: Aetna Medicare |
$47.51
|
| Rate for Payer: Aetna Medicare |
$35.63
|
| Rate for Payer: ASR ASR |
$93.41
|
| Rate for Payer: ASR ASR |
$124.55
|
| Rate for Payer: ASR ASR |
$31.14
|
| Rate for Payer: BCBS Complete |
$51.36
|
| Rate for Payer: BCBS Complete |
$38.52
|
| Rate for Payer: BCBS Complete |
$12.84
|
| Rate for Payer: BCBS Trust/PPO |
$105.87
|
| Rate for Payer: BCBS Trust/PPO |
$26.47
|
| Rate for Payer: BCBS Trust/PPO |
$79.40
|
| Rate for Payer: BCN Commercial |
$105.87
|
| Rate for Payer: BCN Commercial |
$26.47
|
| Rate for Payer: BCN Commercial |
$79.40
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cash Price |
$102.72
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: Cash Price |
$102.72
|
| Rate for Payer: Cofinity Commercial |
$30.17
|
| Rate for Payer: Cofinity Commercial |
$120.70
|
| Rate for Payer: Cofinity Commercial |
$90.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Healthscope Commercial |
$93.41
|
| Rate for Payer: Healthscope Commercial |
$124.55
|
| Rate for Payer: Healthscope Commercial |
$31.14
|
| Rate for Payer: Healthscope Whirlpool |
$32.10
|
| Rate for Payer: Healthscope Whirlpool |
$128.40
|
| Rate for Payer: Healthscope Whirlpool |
$96.30
|
| Rate for Payer: Mclaren Commercial |
$86.67
|
| Rate for Payer: Mclaren Commercial |
$28.89
|
| Rate for Payer: Mclaren Commercial |
$115.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.14
|
| Rate for Payer: Nomi Health Commercial |
$78.97
|
| Rate for Payer: Nomi Health Commercial |
$105.29
|
| Rate for Payer: Nomi Health Commercial |
$26.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.87
|
| Rate for Payer: Priority Health Narrow Network |
$1.50
|
| Rate for Payer: Priority Health Narrow Network |
$1.50
|
| Rate for Payer: Priority Health Narrow Network |
$1.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.99
|
|
|
GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$128.40
|
|
|
Service Code
|
HCPCS A9577
|
| Hospital Charge Code |
41137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.30 |
| Max. Negotiated Rate |
$128.40 |
| Rate for Payer: Aetna Commercial |
$115.56
|
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna Commercial |
$28.89
|
| Rate for Payer: ASR ASR |
$93.41
|
| Rate for Payer: ASR ASR |
$124.55
|
| Rate for Payer: ASR ASR |
$31.14
|
| Rate for Payer: BCBS Trust/PPO |
$79.08
|
| Rate for Payer: BCBS Trust/PPO |
$105.44
|
| Rate for Payer: BCBS Trust/PPO |
$26.36
|
| Rate for Payer: BCN Commercial |
$26.36
|
| Rate for Payer: BCN Commercial |
$105.44
|
| Rate for Payer: BCN Commercial |
$79.08
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: Cash Price |
$102.72
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Commercial |
$120.70
|
| Rate for Payer: Cofinity Commercial |
$30.17
|
| Rate for Payer: Cofinity Commercial |
$90.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Healthscope Commercial |
$31.14
|
| Rate for Payer: Healthscope Commercial |
$124.55
|
| Rate for Payer: Healthscope Commercial |
$93.41
|
| Rate for Payer: Healthscope Whirlpool |
$32.10
|
| Rate for Payer: Healthscope Whirlpool |
$96.30
|
| Rate for Payer: Healthscope Whirlpool |
$128.40
|
| Rate for Payer: Mclaren Commercial |
$28.89
|
| Rate for Payer: Mclaren Commercial |
$115.56
|
| Rate for Payer: Mclaren Commercial |
$86.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.14
|
| Rate for Payer: Nomi Health Commercial |
$26.32
|
| Rate for Payer: Nomi Health Commercial |
$105.29
|
| Rate for Payer: Nomi Health Commercial |
$78.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.99
|
|
|
GADOBUTROL 10 MMOL/10 ML (1 MMOL/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.97
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
152500
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.23 |
| Max. Negotiated Rate |
$18.97 |
| Rate for Payer: Aetna Commercial |
$17.07
|
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: ASR ASR |
$80.51
|
| Rate for Payer: ASR ASR |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$68.16
|
| Rate for Payer: BCBS Trust/PPO |
$15.58
|
| Rate for Payer: BCN Commercial |
$68.16
|
| Rate for Payer: BCN Commercial |
$15.58
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$15.18
|
| Rate for Payer: Cofinity Commercial |
$17.83
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.18
|
| Rate for Payer: Healthscope Commercial |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$80.51
|
| Rate for Payer: Healthscope Whirlpool |
$83.00
|
| Rate for Payer: Healthscope Whirlpool |
$18.97
|
| Rate for Payer: Mclaren Commercial |
$74.70
|
| Rate for Payer: Mclaren Commercial |
$17.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.12
|
| Rate for Payer: Nomi Health Commercial |
$68.06
|
| Rate for Payer: Nomi Health Commercial |
$15.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.04
|
|
|
GADOBUTROL 10 MMOL/10 ML (1 MMOL/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
152500
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Commercial |
$17.07
|
| Rate for Payer: Aetna Medicare |
$7.02
|
| Rate for Payer: Aetna Medicare |
$30.71
|
| Rate for Payer: ASR ASR |
$80.51
|
| Rate for Payer: ASR ASR |
$18.40
|
| Rate for Payer: BCBS Complete |
$7.59
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS Trust/PPO |
$68.43
|
| Rate for Payer: BCBS Trust/PPO |
$15.64
|
| Rate for Payer: BCN Commercial |
$15.64
|
| Rate for Payer: BCN Commercial |
$68.43
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$15.18
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$15.18
|
| Rate for Payer: Cofinity Commercial |
$17.83
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.18
|
| Rate for Payer: Healthscope Commercial |
$80.51
|
| Rate for Payer: Healthscope Commercial |
$18.40
|
| Rate for Payer: Healthscope Whirlpool |
$83.00
|
| Rate for Payer: Healthscope Whirlpool |
$18.97
|
| Rate for Payer: Mclaren Commercial |
$74.70
|
| Rate for Payer: Mclaren Commercial |
$17.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.55
|
| Rate for Payer: Nomi Health Commercial |
$15.56
|
| Rate for Payer: Nomi Health Commercial |
$68.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.29
|
| Rate for Payer: Priority Health Narrow Network |
$0.23
|
| Rate for Payer: Priority Health Narrow Network |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.04
|
|
|
GADODIAMIDE 10 MMOL/20 ML (287 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$428.36
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
118316
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$428.36 |
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna Commercial |
$1,602.00
|
| Rate for Payer: Aetna Medicare |
$658.60
|
| Rate for Payer: Aetna Medicare |
$158.49
|
| Rate for Payer: ASR ASR |
$415.51
|
| Rate for Payer: ASR ASR |
$1,726.60
|
| Rate for Payer: BCBS Complete |
$712.00
|
| Rate for Payer: BCBS Complete |
$171.34
|
| Rate for Payer: BCBS Trust/PPO |
$353.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,467.61
|
| Rate for Payer: BCN Commercial |
$1,467.61
|
| Rate for Payer: BCN Commercial |
$353.18
|
| Rate for Payer: Cash Price |
$342.69
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cash Price |
$342.69
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cofinity Commercial |
$1,673.20
|
| Rate for Payer: Cofinity Commercial |
$402.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,424.00
|
| Rate for Payer: Healthscope Commercial |
$415.51
|
| Rate for Payer: Healthscope Commercial |
$1,726.60
|
| Rate for Payer: Healthscope Whirlpool |
$428.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,780.00
|
| Rate for Payer: Mclaren Commercial |
$385.52
|
| Rate for Payer: Mclaren Commercial |
$1,602.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$342.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,424.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,513.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.10
|
| Rate for Payer: Nomi Health Commercial |
$1,459.60
|
| Rate for Payer: Nomi Health Commercial |
$351.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,335.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.07
|
| Rate for Payer: Priority Health Narrow Network |
$7.26
|
| Rate for Payer: Priority Health Narrow Network |
$7.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,566.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.95
|
|
|
GADODIAMIDE 10 MMOL/20 ML (287 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,780.00
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
118316
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,335.00 |
| Max. Negotiated Rate |
$1,780.00 |
| Rate for Payer: Aetna Commercial |
$1,602.00
|
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: ASR ASR |
$415.51
|
| Rate for Payer: ASR ASR |
$1,726.60
|
| Rate for Payer: BCBS Trust/PPO |
$351.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,461.74
|
| Rate for Payer: BCN Commercial |
$351.77
|
| Rate for Payer: BCN Commercial |
$1,461.74
|
| Rate for Payer: Cash Price |
$342.69
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cofinity Commercial |
$1,673.20
|
| Rate for Payer: Cofinity Commercial |
$402.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,424.00
|
| Rate for Payer: Healthscope Commercial |
$1,726.60
|
| Rate for Payer: Healthscope Commercial |
$415.51
|
| Rate for Payer: Healthscope Whirlpool |
$428.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,780.00
|
| Rate for Payer: Mclaren Commercial |
$385.52
|
| Rate for Payer: Mclaren Commercial |
$1,602.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,513.00
|
| Rate for Payer: Nomi Health Commercial |
$351.25
|
| Rate for Payer: Nomi Health Commercial |
$1,459.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,335.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,566.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.95
|
|
|
GADODIAMIDE 7.5 MMOL/15 ML (287 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
118315
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$1,080.00
|
| Rate for Payer: Aetna Medicare |
$444.00
|
| Rate for Payer: ASR ASR |
$1,164.00
|
| Rate for Payer: BCBS Complete |
$480.00
|
| Rate for Payer: BCBS Trust/PPO |
$989.40
|
| Rate for Payer: BCN Commercial |
$989.40
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cofinity Commercial |
$1,128.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.00
|
| Rate for Payer: Healthscope Commercial |
$1,164.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,200.00
|
| Rate for Payer: Mclaren Commercial |
$1,080.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$960.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,020.00
|
| Rate for Payer: Nomi Health Commercial |
$984.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$900.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.07
|
| Rate for Payer: Priority Health Narrow Network |
$7.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,056.00
|
|
|
GADODIAMIDE 7.5 MMOL/15 ML (287 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
118315
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$1,080.00
|
| Rate for Payer: ASR ASR |
$1,164.00
|
| Rate for Payer: BCBS Trust/PPO |
$985.44
|
| Rate for Payer: BCN Commercial |
$985.44
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cofinity Commercial |
$1,128.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.00
|
| Rate for Payer: Healthscope Commercial |
$1,164.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,200.00
|
| Rate for Payer: Mclaren Commercial |
$1,080.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,020.00
|
| Rate for Payer: Nomi Health Commercial |
$984.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$900.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,056.00
|
|
|
GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$631.72
|
|
|
Service Code
|
HCPCS A9581
|
| Hospital Charge Code |
93574
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$473.79 |
| Max. Negotiated Rate |
$631.72 |
| Rate for Payer: Aetna Commercial |
$568.55
|
| Rate for Payer: ASR ASR |
$612.77
|
| Rate for Payer: BCBS Trust/PPO |
$518.77
|
| Rate for Payer: BCN Commercial |
$518.77
|
| Rate for Payer: Cash Price |
$505.38
|
| Rate for Payer: Cofinity Commercial |
$593.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.38
|
| Rate for Payer: Healthscope Commercial |
$612.77
|
| Rate for Payer: Healthscope Whirlpool |
$631.72
|
| Rate for Payer: Mclaren Commercial |
$568.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$536.96
|
| Rate for Payer: Nomi Health Commercial |
$518.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$473.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$555.92
|
|
|
GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$631.72
|
|
|
Service Code
|
HCPCS A9581
|
| Hospital Charge Code |
93574
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$631.72 |
| Rate for Payer: Aetna Commercial |
$568.55
|
| Rate for Payer: Aetna Medicare |
$233.74
|
| Rate for Payer: ASR ASR |
$612.77
|
| Rate for Payer: BCBS Complete |
$252.69
|
| Rate for Payer: BCBS Trust/PPO |
$520.85
|
| Rate for Payer: BCN Commercial |
$520.85
|
| Rate for Payer: Cash Price |
$505.38
|
| Rate for Payer: Cash Price |
$505.38
|
| Rate for Payer: Cofinity Commercial |
$593.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.38
|
| Rate for Payer: Healthscope Commercial |
$612.77
|
| Rate for Payer: Healthscope Whirlpool |
$631.72
|
| Rate for Payer: Mclaren Commercial |
$568.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$505.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$536.96
|
| Rate for Payer: Nomi Health Commercial |
$518.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$473.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15.31
|
| Rate for Payer: Priority Health Narrow Network |
$12.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$555.92
|
|
|
GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$130.61
|
|
|
Service Code
|
HCPCS J1570
|
| Hospital Charge Code |
10101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.96 |
| Max. Negotiated Rate |
$130.61 |
| Rate for Payer: Aetna Commercial |
$117.55
|
| Rate for Payer: ASR ASR |
$126.69
|
| Rate for Payer: BCBS Trust/PPO |
$107.26
|
| Rate for Payer: BCN Commercial |
$107.26
|
| Rate for Payer: Cash Price |
$104.49
|
| Rate for Payer: Cofinity Commercial |
$122.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.49
|
| Rate for Payer: Healthscope Commercial |
$126.69
|
| Rate for Payer: Healthscope Whirlpool |
$130.61
|
| Rate for Payer: Mclaren Commercial |
$117.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.02
|
| Rate for Payer: Nomi Health Commercial |
$107.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.94
|
|
|
GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$130.61
|
|
|
Service Code
|
HCPCS J1570
|
| Hospital Charge Code |
10101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.83 |
| Max. Negotiated Rate |
$130.61 |
| Rate for Payer: Aetna Commercial |
$117.55
|
| Rate for Payer: Aetna Medicare |
$48.33
|
| Rate for Payer: ASR ASR |
$126.69
|
| Rate for Payer: BCBS Complete |
$52.24
|
| Rate for Payer: BCBS Trust/PPO |
$107.69
|
| Rate for Payer: BCN Commercial |
$107.69
|
| Rate for Payer: Cash Price |
$104.49
|
| Rate for Payer: Cash Price |
$104.49
|
| Rate for Payer: Cofinity Commercial |
$122.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.49
|
| Rate for Payer: Healthscope Commercial |
$126.69
|
| Rate for Payer: Healthscope Whirlpool |
$130.61
|
| Rate for Payer: Mclaren Commercial |
$117.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.02
|
| Rate for Payer: Nomi Health Commercial |
$107.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34.79
|
| Rate for Payer: Priority Health Narrow Network |
$27.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.94
|
|
|
GASTROINTESTINAL HEMORRHAGE WITH CC
|
Facility
|
IP
|
$13,665.90
|
|
|
Service Code
|
MSDRG 378
|
| Min. Negotiated Rate |
$8,375.87 |
| Max. Negotiated Rate |
$13,665.90 |
| Rate for Payer: Aetna Medicare |
$8,816.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,020.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,020.89
|
| Rate for Payer: BCBS MAPPO |
$8,816.71
|
| Rate for Payer: BCN Medicare Advantage |
$8,816.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,816.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,816.71
|
| Rate for Payer: Mclaren Medicare |
$8,816.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,257.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,139.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,698.38
|
| Rate for Payer: PACE Medicare |
$8,375.87
|
| Rate for Payer: PACE SWMI |
$8,816.71
|
| Rate for Payer: PHP Commercial |
$9,698.38
|
| Rate for Payer: PHP Medicare Advantage |
$8,816.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13,473.64
|
| Rate for Payer: Priority Health Medicare |
$8,816.71
|
| Rate for Payer: Priority Health Narrow Network |
$10,778.91
|
| Rate for Payer: Railroad Medicare Medicare |
$8,816.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,816.71
|
| Rate for Payer: UHC Exchange |
$13,665.90
|
| Rate for Payer: UHCCP DNSP |
$8,816.71
|
| Rate for Payer: VA VA |
$8,816.71
|
|
|
GASTROINTESTINAL HEMORRHAGE WITH MCC
|
Facility
|
IP
|
$25,114.53
|
|
|
Service Code
|
MSDRG 377
|
| Min. Negotiated Rate |
$14,172.41 |
| Max. Negotiated Rate |
$25,114.53 |
| Rate for Payer: Aetna Medicare |
$14,918.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,647.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,647.91
|
| Rate for Payer: BCBS MAPPO |
$14,918.33
|
| Rate for Payer: BCN Medicare Advantage |
$14,918.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,918.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,918.33
|
| Rate for Payer: Mclaren Medicare |
$14,918.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,664.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,156.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,410.16
|
| Rate for Payer: PACE Medicare |
$14,172.41
|
| Rate for Payer: PACE SWMI |
$14,918.33
|
| Rate for Payer: PHP Commercial |
$16,410.16
|
| Rate for Payer: PHP Medicare Advantage |
$14,918.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$25,114.53
|
| Rate for Payer: Priority Health Medicare |
$14,918.33
|
| Rate for Payer: Priority Health Narrow Network |
$20,091.62
|
| Rate for Payer: Railroad Medicare Medicare |
$14,918.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,918.33
|
| Rate for Payer: UHC Exchange |
$23,123.41
|
| Rate for Payer: UHCCP DNSP |
$14,918.33
|
| Rate for Payer: VA VA |
$14,918.33
|
|
|
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC
|
Facility
|
IP
|
$9,755.90
|
|
|
Service Code
|
MSDRG 379
|
| Min. Negotiated Rate |
$5,979.42 |
| Max. Negotiated Rate |
$9,755.90 |
| Rate for Payer: Aetna Medicare |
$6,294.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,867.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,867.66
|
| Rate for Payer: BCBS MAPPO |
$6,294.13
|
| Rate for Payer: BCN Medicare Advantage |
$6,294.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,294.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,294.13
|
| Rate for Payer: Mclaren Medicare |
$6,294.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,608.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,238.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,923.54
|
| Rate for Payer: PACE Medicare |
$5,979.42
|
| Rate for Payer: PACE SWMI |
$6,294.13
|
| Rate for Payer: PHP Commercial |
$6,923.54
|
| Rate for Payer: PHP Medicare Advantage |
$6,294.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8,660.94
|
| Rate for Payer: Priority Health Medicare |
$6,294.13
|
| Rate for Payer: Priority Health Narrow Network |
$6,928.75
|
| Rate for Payer: Railroad Medicare Medicare |
$6,294.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,294.13
|
| Rate for Payer: UHC Exchange |
$9,755.90
|
| Rate for Payer: UHCCP DNSP |
$6,294.13
|
| Rate for Payer: VA VA |
$6,294.13
|
|
|
GASTROINTESTINAL OBSTRUCTION WITH CC
|
Facility
|
IP
|
$11,535.10
|
|
|
Service Code
|
MSDRG 389
|
| Min. Negotiated Rate |
$7,069.90 |
| Max. Negotiated Rate |
$11,535.10 |
| Rate for Payer: Aetna Medicare |
$7,442.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,302.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,302.50
|
| Rate for Payer: BCBS MAPPO |
$7,442.00
|
| Rate for Payer: BCN Medicare Advantage |
$7,442.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,442.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,442.00
|
| Rate for Payer: Mclaren Medicare |
$7,442.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,814.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,558.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,186.20
|
| Rate for Payer: PACE Medicare |
$7,069.90
|
| Rate for Payer: PACE SWMI |
$7,442.00
|
| Rate for Payer: PHP Commercial |
$8,186.20
|
| Rate for Payer: PHP Medicare Advantage |
$7,442.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,850.90
|
| Rate for Payer: Priority Health Medicare |
$7,442.00
|
| Rate for Payer: Priority Health Narrow Network |
$8,680.72
|
| Rate for Payer: Railroad Medicare Medicare |
$7,442.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,442.00
|
| Rate for Payer: UHC Exchange |
$11,535.10
|
| Rate for Payer: UHCCP DNSP |
$7,442.00
|
| Rate for Payer: VA VA |
$7,442.00
|
|
|
GASTROINTESTINAL OBSTRUCTION WITH MCC
|
Facility
|
IP
|
$20,289.46
|
|
|
Service Code
|
MSDRG 388
|
| Min. Negotiated Rate |
$11,769.80 |
| Max. Negotiated Rate |
$20,289.46 |
| Rate for Payer: Aetna Medicare |
$12,389.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,486.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,486.58
|
| Rate for Payer: BCBS MAPPO |
$12,389.26
|
| Rate for Payer: BCN Medicare Advantage |
$12,389.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,389.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,389.26
|
| Rate for Payer: Mclaren Medicare |
$12,389.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,008.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,247.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,628.19
|
| Rate for Payer: PACE Medicare |
$11,769.80
|
| Rate for Payer: PACE SWMI |
$12,389.26
|
| Rate for Payer: PHP Commercial |
$13,628.19
|
| Rate for Payer: PHP Medicare Advantage |
$12,389.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20,289.46
|
| Rate for Payer: Priority Health Medicare |
$12,389.26
|
| Rate for Payer: Priority Health Narrow Network |
$16,231.57
|
| Rate for Payer: Railroad Medicare Medicare |
$12,389.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,389.26
|
| Rate for Payer: UHC Exchange |
$19,203.35
|
| Rate for Payer: UHCCP DNSP |
$12,389.26
|
| Rate for Payer: VA VA |
$12,389.26
|
|
|
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC
|
Facility
|
IP
|
$8,791.51
|
|
|
Service Code
|
MSDRG 390
|
| Min. Negotiated Rate |
$5,388.34 |
| Max. Negotiated Rate |
$8,791.51 |
| Rate for Payer: Aetna Medicare |
$5,671.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,089.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,089.93
|
| Rate for Payer: BCBS MAPPO |
$5,671.94
|
| Rate for Payer: BCN Medicare Advantage |
$5,671.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,671.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,671.94
|
| Rate for Payer: Mclaren Medicare |
$5,671.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,955.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,522.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,239.13
|
| Rate for Payer: PACE Medicare |
$5,388.34
|
| Rate for Payer: PACE SWMI |
$5,671.94
|
| Rate for Payer: PHP Commercial |
$6,239.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,671.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,473.91
|
| Rate for Payer: Priority Health Medicare |
$5,671.94
|
| Rate for Payer: Priority Health Narrow Network |
$5,979.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,671.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,671.94
|
| Rate for Payer: UHC Exchange |
$8,791.51
|
| Rate for Payer: UHCCP DNSP |
$5,671.94
|
| Rate for Payer: VA VA |
$5,671.94
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$7,942.10
|
|
|
Service Code
|
APR-DRG 2463
|
| Min. Negotiated Rate |
$7,180.61 |
| Max. Negotiated Rate |
$7,942.10 |
| Rate for Payer: BCBS Complete |
$7,942.10
|
| Rate for Payer: Mclaren Medicaid |
$7,563.91
|
| Rate for Payer: Meridian Medicaid |
$7,942.10
|
| Rate for Payer: PHP Medicaid |
$7,180.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,563.91
|
| Rate for Payer: UHC Medicaid |
$7,563.91
|
| Rate for Payer: UHCCP Medicaid |
$7,563.91
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$5,439.15
|
|
|
Service Code
|
APR-DRG 2462
|
| Min. Negotiated Rate |
$4,917.64 |
| Max. Negotiated Rate |
$5,439.15 |
| Rate for Payer: BCBS Complete |
$5,439.15
|
| Rate for Payer: Mclaren Medicaid |
$5,180.14
|
| Rate for Payer: Meridian Medicaid |
$5,439.15
|
| Rate for Payer: PHP Medicaid |
$4,917.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,180.14
|
| Rate for Payer: UHC Medicaid |
$5,180.14
|
| Rate for Payer: UHCCP Medicaid |
$5,180.14
|
|
