|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$64.75
|
|
|
Service Code
|
NDC 65862067601
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.96 |
| Max. Negotiated Rate |
$64.75 |
| Rate for Payer: Aetna Commercial |
$58.27
|
| Rate for Payer: Aetna Medicare |
$23.96
|
| Rate for Payer: ASR ASR |
$62.81
|
| Rate for Payer: BCBS Complete |
$25.90
|
| Rate for Payer: BCBS Trust/PPO |
$53.39
|
| Rate for Payer: BCN Commercial |
$53.39
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cofinity Commercial |
$60.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Healthscope Commercial |
$62.81
|
| Rate for Payer: Healthscope Whirlpool |
$64.75
|
| Rate for Payer: Mclaren Commercial |
$58.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.04
|
| Rate for Payer: Nomi Health Commercial |
$53.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$56.73
|
| Rate for Payer: Priority Health Narrow Network |
$45.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.98
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$64.75
|
|
|
Service Code
|
NDC 65862067601
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.56 |
| Max. Negotiated Rate |
$64.75 |
| Rate for Payer: Aetna Commercial |
$58.27
|
| Rate for Payer: ASR ASR |
$62.81
|
| Rate for Payer: BCBS Trust/PPO |
$53.17
|
| Rate for Payer: BCN Commercial |
$53.17
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cofinity Commercial |
$60.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Healthscope Commercial |
$62.81
|
| Rate for Payer: Healthscope Whirlpool |
$64.75
|
| Rate for Payer: Mclaren Commercial |
$58.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.04
|
| Rate for Payer: Nomi Health Commercial |
$53.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.98
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$0.93
|
|
|
Service Code
|
NDC 51079078901
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare |
$0.34
|
| Rate for Payer: ASR ASR |
$0.90
|
| Rate for Payer: BCBS Complete |
$0.37
|
| Rate for Payer: BCBS Trust/PPO |
$0.77
|
| Rate for Payer: BCN Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cofinity Commercial |
$0.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$0.90
|
| Rate for Payer: Healthscope Whirlpool |
$0.93
|
| Rate for Payer: Mclaren Commercial |
$0.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.79
|
| Rate for Payer: Nomi Health Commercial |
$0.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.81
|
| Rate for Payer: Priority Health Narrow Network |
$0.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.82
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$6.67
|
|
|
Service Code
|
NDC 60687038811
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Aetna Commercial |
$6.00
|
| Rate for Payer: Aetna Medicare |
$2.47
|
| Rate for Payer: ASR ASR |
$6.47
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$5.50
|
| Rate for Payer: BCN Commercial |
$5.50
|
| Rate for Payer: Cash Price |
$5.33
|
| Rate for Payer: Cofinity Commercial |
$6.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.33
|
| Rate for Payer: Healthscope Commercial |
$6.47
|
| Rate for Payer: Healthscope Whirlpool |
$6.67
|
| Rate for Payer: Mclaren Commercial |
$6.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.67
|
| Rate for Payer: Nomi Health Commercial |
$5.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.84
|
| Rate for Payer: Priority Health Narrow Network |
$4.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.87
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$666.75
|
|
|
Service Code
|
NDC 60687038801
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.70 |
| Max. Negotiated Rate |
$666.75 |
| Rate for Payer: Aetna Commercial |
$600.08
|
| Rate for Payer: Aetna Medicare |
$246.70
|
| Rate for Payer: ASR ASR |
$646.75
|
| Rate for Payer: BCBS Complete |
$266.70
|
| Rate for Payer: BCBS Trust/PPO |
$549.74
|
| Rate for Payer: BCN Commercial |
$549.74
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cofinity Commercial |
$626.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.40
|
| Rate for Payer: Healthscope Commercial |
$646.75
|
| Rate for Payer: Healthscope Whirlpool |
$666.75
|
| Rate for Payer: Mclaren Commercial |
$600.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$533.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.74
|
| Rate for Payer: Nomi Health Commercial |
$546.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$500.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$584.21
|
| Rate for Payer: Priority Health Narrow Network |
$467.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$586.74
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$0.93
|
|
|
Service Code
|
NDC 51079078901
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: ASR ASR |
$0.90
|
| Rate for Payer: BCBS Trust/PPO |
$0.76
|
| Rate for Payer: BCN Commercial |
$0.76
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cofinity Commercial |
$0.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$0.90
|
| Rate for Payer: Healthscope Whirlpool |
$0.93
|
| Rate for Payer: Mclaren Commercial |
$0.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.79
|
| Rate for Payer: Nomi Health Commercial |
$0.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.82
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$6.67
|
|
|
Service Code
|
NDC 60687038811
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Aetna Commercial |
$6.00
|
| Rate for Payer: ASR ASR |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$5.48
|
| Rate for Payer: BCN Commercial |
$5.48
|
| Rate for Payer: Cash Price |
$5.33
|
| Rate for Payer: Cofinity Commercial |
$6.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.33
|
| Rate for Payer: Healthscope Commercial |
$6.47
|
| Rate for Payer: Healthscope Whirlpool |
$6.67
|
| Rate for Payer: Mclaren Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.67
|
| Rate for Payer: Nomi Health Commercial |
$5.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.87
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$68.25
|
|
|
Service Code
|
NDC 65862067701
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Aetna Commercial |
$61.42
|
| Rate for Payer: ASR ASR |
$66.20
|
| Rate for Payer: BCBS Trust/PPO |
$56.05
|
| Rate for Payer: BCN Commercial |
$56.05
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$64.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.60
|
| Rate for Payer: Healthscope Commercial |
$66.20
|
| Rate for Payer: Healthscope Whirlpool |
$68.25
|
| Rate for Payer: Mclaren Commercial |
$61.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.01
|
| Rate for Payer: Nomi Health Commercial |
$55.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.06
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$68.25
|
|
|
Service Code
|
NDC 65862067701
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Aetna Commercial |
$61.42
|
| Rate for Payer: Aetna Medicare |
$25.25
|
| Rate for Payer: ASR ASR |
$66.20
|
| Rate for Payer: BCBS Complete |
$27.30
|
| Rate for Payer: BCBS Trust/PPO |
$56.27
|
| Rate for Payer: BCN Commercial |
$56.27
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$64.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.60
|
| Rate for Payer: Healthscope Commercial |
$66.20
|
| Rate for Payer: Healthscope Whirlpool |
$68.25
|
| Rate for Payer: Mclaren Commercial |
$61.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.01
|
| Rate for Payer: Nomi Health Commercial |
$55.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$59.80
|
| Rate for Payer: Priority Health Narrow Network |
$47.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.06
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$666.75
|
|
|
Service Code
|
NDC 60687038801
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$500.06 |
| Max. Negotiated Rate |
$666.75 |
| Rate for Payer: Aetna Commercial |
$600.08
|
| Rate for Payer: ASR ASR |
$646.75
|
| Rate for Payer: BCBS Trust/PPO |
$547.54
|
| Rate for Payer: BCN Commercial |
$547.54
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cofinity Commercial |
$626.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.40
|
| Rate for Payer: Healthscope Commercial |
$646.75
|
| Rate for Payer: Healthscope Whirlpool |
$666.75
|
| Rate for Payer: Mclaren Commercial |
$600.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.74
|
| Rate for Payer: Nomi Health Commercial |
$546.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$500.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$586.74
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: Aetna Medicare |
$95.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$23,775.28
|
| Rate for Payer: BCN Commercial |
$23,775.28
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$27,970.92
|
| Rate for Payer: Healthscope Whirlpool |
$28,836.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$95.09
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Mclaren Medicaid |
$95.09
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$52.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$104.60
|
| Rate for Payer: PHP Medicaid |
$50.97
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.37
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health Narrow Network |
$77.90
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$147.39
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP DNSP |
$95.09
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: VA VA |
$95.09
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21,627.00 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: BCBS Trust/PPO |
$23,680.12
|
| Rate for Payer: BCN Commercial |
$23,680.12
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$27,970.92
|
| Rate for Payer: Healthscope Whirlpool |
$28,836.00
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
|
|
ALTEPLASE 100 MG IV INFUSION FOR STROKE
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: Aetna Medicare |
$95.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$23,775.28
|
| Rate for Payer: BCN Commercial |
$23,775.28
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$27,970.92
|
| Rate for Payer: Healthscope Whirlpool |
$28,836.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$95.09
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Mclaren Medicaid |
$95.09
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$52.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$104.60
|
| Rate for Payer: PHP Medicaid |
$50.97
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.37
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health Narrow Network |
$77.90
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$147.39
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP DNSP |
$95.09
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: VA VA |
$95.09
|
|
|
ALTEPLASE 100 MG IV INFUSION FOR STROKE
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21,627.00 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: BCBS Trust/PPO |
$23,680.12
|
| Rate for Payer: BCN Commercial |
$23,680.12
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$27,970.92
|
| Rate for Payer: Healthscope Whirlpool |
$28,836.00
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
|
|
ALTEPLASE 100MG IV SOLUTION FOR PE
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: Aetna Medicare |
$95.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$23,775.28
|
| Rate for Payer: BCN Commercial |
$23,775.28
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$27,970.92
|
| Rate for Payer: Healthscope Whirlpool |
$28,836.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$95.09
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Mclaren Medicaid |
$95.09
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$52.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$104.60
|
| Rate for Payer: PHP Medicaid |
$50.97
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.37
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health Narrow Network |
$77.90
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$147.39
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP DNSP |
$95.09
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: VA VA |
$95.09
|
|
|
ALTEPLASE 100MG IV SOLUTION FOR PE
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21,627.00 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: BCBS Trust/PPO |
$23,680.12
|
| Rate for Payer: BCN Commercial |
$23,680.12
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$27,970.92
|
| Rate for Payer: Healthscope Whirlpool |
$28,836.00
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION
|
Facility
|
IP
|
$672.93
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
31310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$504.70 |
| Max. Negotiated Rate |
$672.93 |
| Rate for Payer: Aetna Commercial |
$605.64
|
| Rate for Payer: Aetna Commercial |
$605.68
|
| Rate for Payer: ASR ASR |
$652.74
|
| Rate for Payer: ASR ASR |
$652.78
|
| Rate for Payer: BCBS Trust/PPO |
$552.61
|
| Rate for Payer: BCBS Trust/PPO |
$552.65
|
| Rate for Payer: BCN Commercial |
$552.61
|
| Rate for Payer: BCN Commercial |
$552.65
|
| Rate for Payer: Cash Price |
$538.38
|
| Rate for Payer: Cash Price |
$538.34
|
| Rate for Payer: Cofinity Commercial |
$632.60
|
| Rate for Payer: Cofinity Commercial |
$632.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.38
|
| Rate for Payer: Healthscope Commercial |
$652.74
|
| Rate for Payer: Healthscope Commercial |
$652.78
|
| Rate for Payer: Healthscope Whirlpool |
$672.97
|
| Rate for Payer: Healthscope Whirlpool |
$672.93
|
| Rate for Payer: Mclaren Commercial |
$605.68
|
| Rate for Payer: Mclaren Commercial |
$605.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$571.99
|
| Rate for Payer: Nomi Health Commercial |
$551.84
|
| Rate for Payer: Nomi Health Commercial |
$551.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$504.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$504.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.18
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION
|
Facility
|
OP
|
$672.93
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
31310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$672.93 |
| Rate for Payer: Aetna Commercial |
$605.64
|
| Rate for Payer: Aetna Commercial |
$605.68
|
| Rate for Payer: Aetna Medicare |
$95.09
|
| Rate for Payer: Aetna Medicare |
$95.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: ASR ASR |
$652.74
|
| Rate for Payer: ASR ASR |
$652.78
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$554.87
|
| Rate for Payer: BCBS Trust/PPO |
$554.83
|
| Rate for Payer: BCN Commercial |
$554.87
|
| Rate for Payer: BCN Commercial |
$554.83
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$538.34
|
| Rate for Payer: Cash Price |
$538.34
|
| Rate for Payer: Cash Price |
$538.38
|
| Rate for Payer: Cash Price |
$538.38
|
| Rate for Payer: Cofinity Commercial |
$632.55
|
| Rate for Payer: Cofinity Commercial |
$632.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$652.74
|
| Rate for Payer: Healthscope Commercial |
$652.78
|
| Rate for Payer: Healthscope Whirlpool |
$672.93
|
| Rate for Payer: Healthscope Whirlpool |
$672.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$95.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$95.09
|
| Rate for Payer: Mclaren Commercial |
$605.68
|
| Rate for Payer: Mclaren Commercial |
$605.64
|
| Rate for Payer: Mclaren Medicaid |
$95.09
|
| Rate for Payer: Mclaren Medicaid |
$95.09
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$52.22
|
| Rate for Payer: Meridian Medicaid |
$52.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$571.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.03
|
| Rate for Payer: Nomi Health Commercial |
$551.84
|
| Rate for Payer: Nomi Health Commercial |
$551.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$504.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$504.73
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$104.60
|
| Rate for Payer: PHP Commercial |
$104.60
|
| Rate for Payer: PHP Medicaid |
$50.97
|
| Rate for Payer: PHP Medicaid |
$50.97
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.37
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health Narrow Network |
$77.90
|
| Rate for Payer: Priority Health Narrow Network |
$77.90
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$147.39
|
| Rate for Payer: UHC Exchange |
$147.39
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP DNSP |
$95.09
|
| Rate for Payer: UHCCP DNSP |
$95.09
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: VA VA |
$95.09
|
| Rate for Payer: VA VA |
$95.09
|
|
|
ALTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$14,418.00 |
| Rate for Payer: Aetna Commercial |
$12,976.20
|
| Rate for Payer: Aetna Medicare |
$95.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: ASR ASR |
$13,985.46
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$11,887.64
|
| Rate for Payer: BCN Commercial |
$11,887.64
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Commercial |
$13,552.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$13,985.46
|
| Rate for Payer: Healthscope Whirlpool |
$14,418.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$95.09
|
| Rate for Payer: Mclaren Commercial |
$12,976.20
|
| Rate for Payer: Mclaren Medicaid |
$95.09
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$52.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: Nomi Health Commercial |
$11,822.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,813.50
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$104.60
|
| Rate for Payer: PHP Medicaid |
$50.97
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.37
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health Narrow Network |
$77.90
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,687.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$147.39
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP DNSP |
$95.09
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: VA VA |
$95.09
|
|
|
ALTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,813.50 |
| Max. Negotiated Rate |
$14,418.00 |
| Rate for Payer: Aetna Commercial |
$12,976.20
|
| Rate for Payer: ASR ASR |
$13,985.46
|
| Rate for Payer: BCBS Trust/PPO |
$11,840.06
|
| Rate for Payer: BCN Commercial |
$11,840.06
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Commercial |
$13,552.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Healthscope Commercial |
$13,985.46
|
| Rate for Payer: Healthscope Whirlpool |
$14,418.00
|
| Rate for Payer: Mclaren Commercial |
$12,976.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: Nomi Health Commercial |
$11,822.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,813.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,687.84
|
|
|
ALTEPLASE INFUSION FOR CARDIAC ARREST
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
300766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21,627.00 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: BCBS Trust/PPO |
$23,680.12
|
| Rate for Payer: BCN Commercial |
$23,680.12
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$27,970.92
|
| Rate for Payer: Healthscope Whirlpool |
$28,836.00
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
|
|
ALTEPLASE INFUSION FOR CARDIAC ARREST
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
300766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$28,836.00 |
| Rate for Payer: Aetna Commercial |
$25,952.40
|
| Rate for Payer: Aetna Medicare |
$95.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: ASR ASR |
$27,970.92
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$23,775.28
|
| Rate for Payer: BCN Commercial |
$23,775.28
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$27,105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$27,970.92
|
| Rate for Payer: Healthscope Whirlpool |
$28,836.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$95.09
|
| Rate for Payer: Mclaren Commercial |
$25,952.40
|
| Rate for Payer: Mclaren Medicaid |
$95.09
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$52.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$104.60
|
| Rate for Payer: PHP Medicaid |
$50.97
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.37
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health Narrow Network |
$77.90
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,375.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$147.39
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP DNSP |
$95.09
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: VA VA |
$95.09
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
IP
|
$6,973.73
|
|
|
Service Code
|
APR-DRG 0523
|
| Min. Negotiated Rate |
$6,305.08 |
| Max. Negotiated Rate |
$6,973.73 |
| Rate for Payer: BCBS Complete |
$6,973.73
|
| Rate for Payer: Mclaren Medicaid |
$6,641.64
|
| Rate for Payer: Meridian Medicaid |
$6,973.73
|
| Rate for Payer: PHP Medicaid |
$6,305.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,641.64
|
| Rate for Payer: UHC Medicaid |
$6,641.64
|
| Rate for Payer: UHCCP Medicaid |
$6,641.64
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
IP
|
$3,753.62
|
|
|
Service Code
|
APR-DRG 0521
|
| Min. Negotiated Rate |
$3,393.72 |
| Max. Negotiated Rate |
$3,753.62 |
| Rate for Payer: BCBS Complete |
$3,753.62
|
| Rate for Payer: Mclaren Medicaid |
$3,574.87
|
| Rate for Payer: Meridian Medicaid |
$3,753.62
|
| Rate for Payer: PHP Medicaid |
$3,393.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,574.87
|
| Rate for Payer: UHC Medicaid |
$3,574.87
|
| Rate for Payer: UHCCP Medicaid |
$3,574.87
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
IP
|
$11,573.65
|
|
|
Service Code
|
APR-DRG 0524
|
| Min. Negotiated Rate |
$10,463.96 |
| Max. Negotiated Rate |
$11,573.65 |
| Rate for Payer: BCBS Complete |
$11,573.65
|
| Rate for Payer: Mclaren Medicaid |
$11,022.52
|
| Rate for Payer: Meridian Medicaid |
$11,573.65
|
| Rate for Payer: PHP Medicaid |
$10,463.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,022.52
|
| Rate for Payer: UHC Medicaid |
$11,022.52
|
| Rate for Payer: UHCCP Medicaid |
$11,022.52
|
|
