|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$19.39
|
|
|
Service Code
|
NDC 61990-0611-0
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Aetna Commercial |
$17.45
|
| Rate for Payer: ASR ASR |
$18.81
|
| Rate for Payer: BCBS Trust/PPO |
$15.03
|
| Rate for Payer: BCN Commercial |
$15.03
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.51
|
| Rate for Payer: Healthscope Commercial |
$19.39
|
| Rate for Payer: Healthscope Whirlpool |
$18.81
|
| Rate for Payer: Mclaren Commercial |
$17.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.06
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$51.04
|
|
|
Service Code
|
NDC 0517-0960-10
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.73 |
| Max. Negotiated Rate |
$51.04 |
| Rate for Payer: Aetna Commercial |
$45.94
|
| Rate for Payer: ASR ASR |
$49.51
|
| Rate for Payer: BCBS Trust/PPO |
$39.57
|
| Rate for Payer: BCN Commercial |
$39.57
|
| Rate for Payer: Cash Price |
$40.83
|
| Rate for Payer: Cofinity Commercial |
$47.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.83
|
| Rate for Payer: Healthscope Commercial |
$51.04
|
| Rate for Payer: Healthscope Whirlpool |
$49.51
|
| Rate for Payer: Mclaren Commercial |
$45.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.92
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) SOLUTION CUSTOM
|
Facility
IP
|
$22.74
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
300870
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$22.74 |
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: ASR ASR |
$22.06
|
| Rate for Payer: BCBS Trust/PPO |
$17.63
|
| Rate for Payer: BCN Commercial |
$17.63
|
| Rate for Payer: Cash Price |
$18.19
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.19
|
| Rate for Payer: Healthscope Commercial |
$22.74
|
| Rate for Payer: Healthscope Whirlpool |
$22.06
|
| Rate for Payer: Mclaren Commercial |
$20.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.01
|
|
|
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC
|
Facility
IP
|
$10,553.81
|
|
|
Service Code
|
MS-DRG 069
|
| Min. Negotiated Rate |
$8,020.90 |
| Max. Negotiated Rate |
$10,553.81 |
| Rate for Payer: Aetna Medicare |
$8,443.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,553.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,553.81
|
| Rate for Payer: BCBS MAPPO |
$8,443.05
|
| Rate for Payer: BCN Medicare Advantage |
$8,443.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,443.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,443.05
|
| Rate for Payer: Mclaren Medicare |
$8,443.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,865.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,709.51
|
| Rate for Payer: PACE Medicare |
$8,020.90
|
| Rate for Payer: PACE SWMI |
$8,443.05
|
| Rate for Payer: PHP Commercial |
$9,287.36
|
| Rate for Payer: PHP Medicare Advantage |
$8,443.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,255.31
|
| Rate for Payer: Priority Health Medicare |
$8,443.05
|
| Rate for Payer: Priority Health Narrow Network |
$8,204.25
|
| Rate for Payer: Railroad Medicare Medicare |
$8,443.05
|
| Rate for Payer: UHC Medicare Advantage |
$8,696.34
|
| Rate for Payer: VA VA |
$8,443.05
|
|
|
TRANSURETHRAL PROCEDURES WITH CC
|
Facility
IP
|
$19,704.26
|
|
|
Service Code
|
MS-DRG 669
|
| Min. Negotiated Rate |
$13,939.79 |
| Max. Negotiated Rate |
$19,704.26 |
| Rate for Payer: Priority Health Medicare |
$14,673.46
|
| Rate for Payer: Aetna Medicare |
$14,673.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,341.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,341.82
|
| Rate for Payer: BCBS MAPPO |
$14,673.46
|
| Rate for Payer: BCN Medicare Advantage |
$14,673.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,673.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,673.46
|
| Rate for Payer: Mclaren Medicare |
$14,673.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,407.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,874.48
|
| Rate for Payer: PACE Medicare |
$13,939.79
|
| Rate for Payer: PACE SWMI |
$14,673.46
|
| Rate for Payer: PHP Commercial |
$16,140.81
|
| Rate for Payer: PHP Medicare Advantage |
$14,673.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,704.26
|
| Rate for Payer: Priority Health Narrow Network |
$15,763.41
|
| Rate for Payer: Railroad Medicare Medicare |
$14,673.46
|
| Rate for Payer: UHC Medicare Advantage |
$15,113.66
|
| Rate for Payer: VA VA |
$14,673.46
|
|
|
TRANSURETHRAL PROCEDURES WITH MCC
|
Facility
IP
|
$36,183.12
|
|
|
Service Code
|
MS-DRG 668
|
| Min. Negotiated Rate |
$24,262.28 |
| Max. Negotiated Rate |
$36,183.12 |
| Rate for Payer: Aetna Medicare |
$25,539.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,924.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,924.05
|
| Rate for Payer: BCBS MAPPO |
$25,539.24
|
| Rate for Payer: BCN Medicare Advantage |
$25,539.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,539.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$25,539.24
|
| Rate for Payer: Mclaren Medicare |
$25,539.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26,816.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,370.13
|
| Rate for Payer: PACE Medicare |
$24,262.28
|
| Rate for Payer: PACE SWMI |
$25,539.24
|
| Rate for Payer: PHP Commercial |
$28,093.16
|
| Rate for Payer: PHP Medicare Advantage |
$25,539.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,183.12
|
| Rate for Payer: Priority Health Medicare |
$25,539.24
|
| Rate for Payer: Priority Health Narrow Network |
$28,946.50
|
| Rate for Payer: Railroad Medicare Medicare |
$25,539.24
|
| Rate for Payer: UHC Medicare Advantage |
$26,305.42
|
| Rate for Payer: VA VA |
$25,539.24
|
|
|
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$12,359.78
|
|
|
Service Code
|
MS-DRG 670
|
| Min. Negotiated Rate |
$9,339.16 |
| Max. Negotiated Rate |
$12,359.78 |
| Rate for Payer: Aetna Medicare |
$9,830.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,288.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,288.38
|
| Rate for Payer: BCBS MAPPO |
$9,830.70
|
| Rate for Payer: BCN Medicare Advantage |
$9,830.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,830.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,830.70
|
| Rate for Payer: Mclaren Medicare |
$9,830.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,322.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,305.30
|
| Rate for Payer: PACE Medicare |
$9,339.16
|
| Rate for Payer: PACE SWMI |
$9,830.70
|
| Rate for Payer: PHP Commercial |
$10,813.77
|
| Rate for Payer: PHP Medicare Advantage |
$9,830.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,359.78
|
| Rate for Payer: Priority Health Medicare |
$9,830.70
|
| Rate for Payer: Priority Health Narrow Network |
$9,887.82
|
| Rate for Payer: Railroad Medicare Medicare |
$9,830.70
|
| Rate for Payer: UHC Medicare Advantage |
$10,125.62
|
| Rate for Payer: VA VA |
$9,830.70
|
|
|
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC
|
Facility
IP
|
$18,626.99
|
|
|
Service Code
|
MS-DRG 713
|
| Min. Negotiated Rate |
$13,264.98 |
| Max. Negotiated Rate |
$18,626.99 |
| Rate for Payer: Aetna Medicare |
$13,963.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,453.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,453.92
|
| Rate for Payer: BCBS MAPPO |
$13,963.14
|
| Rate for Payer: BCN Medicare Advantage |
$13,963.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,963.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,963.14
|
| Rate for Payer: Mclaren Medicare |
$13,963.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,661.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,057.61
|
| Rate for Payer: PACE Medicare |
$13,264.98
|
| Rate for Payer: PACE SWMI |
$13,963.14
|
| Rate for Payer: PHP Commercial |
$15,359.45
|
| Rate for Payer: PHP Medicare Advantage |
$13,963.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,626.99
|
| Rate for Payer: Priority Health Medicare |
$13,963.14
|
| Rate for Payer: Priority Health Narrow Network |
$14,901.59
|
| Rate for Payer: Railroad Medicare Medicare |
$13,963.14
|
| Rate for Payer: UHC Medicare Advantage |
$14,382.03
|
| Rate for Payer: VA VA |
$13,963.14
|
|
|
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC
|
Facility
IP
|
$12,307.14
|
|
|
Service Code
|
MS-DRG 714
|
| Min. Negotiated Rate |
$9,306.18 |
| Max. Negotiated Rate |
$12,307.14 |
| Rate for Payer: Aetna Medicare |
$9,795.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,244.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,244.98
|
| Rate for Payer: BCBS MAPPO |
$9,795.98
|
| Rate for Payer: BCN Medicare Advantage |
$9,795.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,795.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,795.98
|
| Rate for Payer: Mclaren Medicare |
$9,795.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,285.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,265.38
|
| Rate for Payer: PACE Medicare |
$9,306.18
|
| Rate for Payer: PACE SWMI |
$9,795.98
|
| Rate for Payer: PHP Commercial |
$10,775.58
|
| Rate for Payer: PHP Medicare Advantage |
$9,795.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,307.14
|
| Rate for Payer: Priority Health Medicare |
$9,795.98
|
| Rate for Payer: Priority Health Narrow Network |
$9,845.71
|
| Rate for Payer: Railroad Medicare Medicare |
$9,795.98
|
| Rate for Payer: UHC Medicare Advantage |
$10,089.86
|
| Rate for Payer: VA VA |
$9,795.98
|
|
|
TRAUMATIC INJURY WITH MCC
|
Facility
IP
|
$19,189.38
|
|
|
Service Code
|
MS-DRG 913
|
| Min. Negotiated Rate |
$13,617.26 |
| Max. Negotiated Rate |
$19,189.38 |
| Rate for Payer: Aetna Medicare |
$14,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,917.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,917.45
|
| Rate for Payer: BCBS MAPPO |
$14,333.96
|
| Rate for Payer: BCN Medicare Advantage |
$14,333.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,333.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,333.96
|
| Rate for Payer: Mclaren Medicare |
$14,333.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,050.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,484.05
|
| Rate for Payer: PACE Medicare |
$13,617.26
|
| Rate for Payer: PACE SWMI |
$14,333.96
|
| Rate for Payer: PHP Commercial |
$15,767.36
|
| Rate for Payer: PHP Medicare Advantage |
$14,333.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,189.38
|
| Rate for Payer: Priority Health Medicare |
$14,333.96
|
| Rate for Payer: Priority Health Narrow Network |
$15,351.50
|
| Rate for Payer: Railroad Medicare Medicare |
$14,333.96
|
| Rate for Payer: UHC Medicare Advantage |
$14,763.98
|
| Rate for Payer: VA VA |
$14,333.96
|
|
|
TRAUMATIC INJURY WITHOUT MCC
|
Facility
IP
|
$11,707.36
|
|
|
Service Code
|
MS-DRG 914
|
| Min. Negotiated Rate |
$8,897.60 |
| Max. Negotiated Rate |
$11,707.36 |
| Rate for Payer: Aetna Medicare |
$9,365.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,707.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,707.36
|
| Rate for Payer: BCBS MAPPO |
$9,365.89
|
| Rate for Payer: BCN Medicare Advantage |
$9,365.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,365.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,365.89
|
| Rate for Payer: Mclaren Medicare |
$9,365.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,834.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,770.77
|
| Rate for Payer: PACE Medicare |
$8,897.60
|
| Rate for Payer: PACE SWMI |
$9,365.89
|
| Rate for Payer: PHP Commercial |
$10,302.48
|
| Rate for Payer: PHP Medicare Advantage |
$9,365.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,654.87
|
| Rate for Payer: Priority Health Medicare |
$9,365.89
|
| Rate for Payer: Priority Health Narrow Network |
$9,323.90
|
| Rate for Payer: Railroad Medicare Medicare |
$9,365.89
|
| Rate for Payer: UHC Medicare Advantage |
$9,646.87
|
| Rate for Payer: VA VA |
$9,365.89
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC
|
Facility
IP
|
$16,911.56
|
|
|
Service Code
|
MS-DRG 086
|
| Min. Negotiated Rate |
$12,190.44 |
| Max. Negotiated Rate |
$16,911.56 |
| Rate for Payer: Aetna Medicare |
$12,832.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,040.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,040.05
|
| Rate for Payer: BCBS MAPPO |
$12,832.04
|
| Rate for Payer: BCN Medicare Advantage |
$12,832.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,832.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,832.04
|
| Rate for Payer: Mclaren Medicare |
$12,832.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,473.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,756.85
|
| Rate for Payer: PACE Medicare |
$12,190.44
|
| Rate for Payer: PACE SWMI |
$12,832.04
|
| Rate for Payer: PHP Commercial |
$14,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$12,832.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,911.56
|
| Rate for Payer: Priority Health Medicare |
$12,832.04
|
| Rate for Payer: Priority Health Narrow Network |
$13,529.25
|
| Rate for Payer: Railroad Medicare Medicare |
$12,832.04
|
| Rate for Payer: UHC Medicare Advantage |
$13,217.00
|
| Rate for Payer: VA VA |
$12,832.04
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC
|
Facility
IP
|
$17,416.18
|
|
|
Service Code
|
MS-DRG 083
|
| Min. Negotiated Rate |
$12,506.51 |
| Max. Negotiated Rate |
$17,416.18 |
| Rate for Payer: Aetna Medicare |
$13,164.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,455.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,455.94
|
| Rate for Payer: BCBS MAPPO |
$13,164.75
|
| Rate for Payer: BCN Medicare Advantage |
$13,164.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,164.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,164.75
|
| Rate for Payer: Mclaren Medicare |
$13,164.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,822.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,139.46
|
| Rate for Payer: PACE Medicare |
$12,506.51
|
| Rate for Payer: PACE SWMI |
$13,164.75
|
| Rate for Payer: PHP Commercial |
$14,481.22
|
| Rate for Payer: PHP Medicare Advantage |
$13,164.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,416.18
|
| Rate for Payer: Priority Health Medicare |
$13,164.75
|
| Rate for Payer: Priority Health Narrow Network |
$13,932.94
|
| Rate for Payer: Railroad Medicare Medicare |
$13,164.75
|
| Rate for Payer: UHC Medicare Advantage |
$13,559.69
|
| Rate for Payer: VA VA |
$13,164.75
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC
|
Facility
IP
|
$29,182.75
|
|
|
Service Code
|
MS-DRG 085
|
| Min. Negotiated Rate |
$19,877.21 |
| Max. Negotiated Rate |
$29,182.75 |
| Rate for Payer: Aetna Medicare |
$20,923.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,154.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,154.22
|
| Rate for Payer: BCBS MAPPO |
$20,923.38
|
| Rate for Payer: BCN Medicare Advantage |
$20,923.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,923.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$20,923.38
|
| Rate for Payer: Mclaren Medicare |
$20,923.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,969.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,061.89
|
| Rate for Payer: PACE Medicare |
$19,877.21
|
| Rate for Payer: PACE SWMI |
$20,923.38
|
| Rate for Payer: PHP Commercial |
$23,015.72
|
| Rate for Payer: PHP Medicare Advantage |
$20,923.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29,182.75
|
| Rate for Payer: Priority Health Medicare |
$20,923.38
|
| Rate for Payer: Priority Health Narrow Network |
$23,346.20
|
| Rate for Payer: Railroad Medicare Medicare |
$20,923.38
|
| Rate for Payer: UHC Medicare Advantage |
$21,551.08
|
| Rate for Payer: VA VA |
$20,923.38
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC
|
Facility
IP
|
$29,253.37
|
|
|
Service Code
|
MS-DRG 082
|
| Min. Negotiated Rate |
$19,921.44 |
| Max. Negotiated Rate |
$29,253.37 |
| Rate for Payer: Aetna Medicare |
$20,969.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,212.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,212.42
|
| Rate for Payer: BCBS MAPPO |
$20,969.94
|
| Rate for Payer: BCN Medicare Advantage |
$20,969.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,969.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$20,969.94
|
| Rate for Payer: Mclaren Medicare |
$20,969.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,018.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,115.43
|
| Rate for Payer: PACE Medicare |
$19,921.44
|
| Rate for Payer: PACE SWMI |
$20,969.94
|
| Rate for Payer: PHP Commercial |
$23,066.93
|
| Rate for Payer: PHP Medicare Advantage |
$20,969.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29,253.37
|
| Rate for Payer: Priority Health Medicare |
$20,969.94
|
| Rate for Payer: Priority Health Narrow Network |
$23,402.70
|
| Rate for Payer: Railroad Medicare Medicare |
$20,969.94
|
| Rate for Payer: UHC Medicare Advantage |
$21,599.04
|
| Rate for Payer: VA VA |
$20,969.94
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC
|
Facility
IP
|
$11,479.81
|
|
|
Service Code
|
MS-DRG 087
|
| Min. Negotiated Rate |
$8,724.66 |
| Max. Negotiated Rate |
$11,479.81 |
| Rate for Payer: Aetna Medicare |
$9,183.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,479.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,479.81
|
| Rate for Payer: BCBS MAPPO |
$9,183.85
|
| Rate for Payer: BCN Medicare Advantage |
$9,183.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,183.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,183.85
|
| Rate for Payer: Mclaren Medicare |
$9,183.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,643.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,561.43
|
| Rate for Payer: PACE Medicare |
$8,724.66
|
| Rate for Payer: PACE SWMI |
$9,183.85
|
| Rate for Payer: PHP Commercial |
$10,102.24
|
| Rate for Payer: PHP Medicare Advantage |
$9,183.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,378.81
|
| Rate for Payer: Priority Health Medicare |
$9,183.85
|
| Rate for Payer: Priority Health Narrow Network |
$9,103.05
|
| Rate for Payer: Railroad Medicare Medicare |
$9,183.85
|
| Rate for Payer: UHC Medicare Advantage |
$9,459.37
|
| Rate for Payer: VA VA |
$9,183.85
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC
|
Facility
IP
|
$11,834.36
|
|
|
Service Code
|
MS-DRG 084
|
| Min. Negotiated Rate |
$8,994.12 |
| Max. Negotiated Rate |
$11,834.36 |
| Rate for Payer: Aetna Medicare |
$9,467.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,834.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,834.36
|
| Rate for Payer: BCBS MAPPO |
$9,467.49
|
| Rate for Payer: BCN Medicare Advantage |
$9,467.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,467.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,467.49
|
| Rate for Payer: Mclaren Medicare |
$9,467.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,940.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,887.61
|
| Rate for Payer: PACE Medicare |
$8,994.12
|
| Rate for Payer: PACE SWMI |
$9,467.49
|
| Rate for Payer: PHP Commercial |
$10,414.24
|
| Rate for Payer: PHP Medicare Advantage |
$9,467.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,808.95
|
| Rate for Payer: Priority Health Medicare |
$9,467.49
|
| Rate for Payer: Priority Health Narrow Network |
$9,447.16
|
| Rate for Payer: Railroad Medicare Medicare |
$9,467.49
|
| Rate for Payer: UHC Medicare Advantage |
$9,751.51
|
| Rate for Payer: VA VA |
$9,467.49
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC
|
Facility
IP
|
$19,339.61
|
|
|
Service Code
|
MS-DRG 604
|
| Min. Negotiated Rate |
$13,711.38 |
| Max. Negotiated Rate |
$19,339.61 |
| Rate for Payer: Aetna Medicare |
$14,433.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,041.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,041.29
|
| Rate for Payer: BCBS MAPPO |
$14,433.03
|
| Rate for Payer: BCN Medicare Advantage |
$14,433.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,433.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,433.03
|
| Rate for Payer: Mclaren Medicare |
$14,433.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,154.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,597.98
|
| Rate for Payer: PACE Medicare |
$13,711.38
|
| Rate for Payer: PACE SWMI |
$14,433.03
|
| Rate for Payer: PHP Commercial |
$15,876.33
|
| Rate for Payer: PHP Medicare Advantage |
$14,433.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,339.61
|
| Rate for Payer: Priority Health Medicare |
$14,433.03
|
| Rate for Payer: Priority Health Narrow Network |
$15,471.69
|
| Rate for Payer: Railroad Medicare Medicare |
$14,433.03
|
| Rate for Payer: UHC Medicare Advantage |
$14,866.02
|
| Rate for Payer: VA VA |
$14,433.03
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC
|
Facility
IP
|
$11,719.00
|
|
|
Service Code
|
MS-DRG 605
|
| Min. Negotiated Rate |
$8,906.44 |
| Max. Negotiated Rate |
$11,719.00 |
| Rate for Payer: Aetna Medicare |
$9,375.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,719.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,719.00
|
| Rate for Payer: BCBS MAPPO |
$9,375.20
|
| Rate for Payer: BCN Medicare Advantage |
$9,375.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,375.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,375.20
|
| Rate for Payer: Mclaren Medicare |
$9,375.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,843.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,781.48
|
| Rate for Payer: PACE Medicare |
$8,906.44
|
| Rate for Payer: PACE SWMI |
$9,375.20
|
| Rate for Payer: PHP Commercial |
$10,312.72
|
| Rate for Payer: PHP Medicare Advantage |
$9,375.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,668.99
|
| Rate for Payer: Priority Health Medicare |
$9,375.20
|
| Rate for Payer: Priority Health Narrow Network |
$9,335.19
|
| Rate for Payer: Railroad Medicare Medicare |
$9,375.20
|
| Rate for Payer: UHC Medicare Advantage |
$9,656.46
|
| Rate for Payer: VA VA |
$9,375.20
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
IP
|
$2.61
|
|
|
Service Code
|
NDC 60687-443-11
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Aetna Commercial |
$2.35
|
| Rate for Payer: ASR ASR |
$2.53
|
| Rate for Payer: BCBS Trust/PPO |
$2.02
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.09
|
| Rate for Payer: Healthscope Commercial |
$2.61
|
| Rate for Payer: Healthscope Whirlpool |
$2.53
|
| Rate for Payer: Mclaren Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.30
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
IP
|
$242.05
|
|
|
Service Code
|
NDC 0904-6868-61
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.44 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna Commercial |
$217.84
|
| Rate for Payer: ASR ASR |
$234.79
|
| Rate for Payer: BCBS Trust/PPO |
$187.66
|
| Rate for Payer: BCN Commercial |
$187.66
|
| Rate for Payer: Cash Price |
$193.64
|
| Rate for Payer: Cofinity Commercial |
$227.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.64
|
| Rate for Payer: Healthscope Commercial |
$242.05
|
| Rate for Payer: Healthscope Whirlpool |
$234.79
|
| Rate for Payer: Mclaren Commercial |
$217.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.00
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
IP
|
$119.85
|
|
|
Service Code
|
NDC 50111-560-01
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.90 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: ASR ASR |
$116.25
|
| Rate for Payer: BCBS Trust/PPO |
$92.92
|
| Rate for Payer: BCN Commercial |
$92.92
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Commercial |
$112.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$119.85
|
| Rate for Payer: Healthscope Whirlpool |
$116.25
|
| Rate for Payer: Mclaren Commercial |
$107.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.47
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
IP
|
$260.85
|
|
|
Service Code
|
NDC 60687-443-01
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.60 |
| Max. Negotiated Rate |
$260.85 |
| Rate for Payer: Aetna Commercial |
$234.76
|
| Rate for Payer: ASR ASR |
$253.02
|
| Rate for Payer: BCBS Trust/PPO |
$202.24
|
| Rate for Payer: BCN Commercial |
$202.24
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$245.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$260.85
|
| Rate for Payer: Healthscope Whirlpool |
$253.02
|
| Rate for Payer: Mclaren Commercial |
$234.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$229.55
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
IP
|
$10.08
|
|
|
Service Code
|
NDC 67877-251-15
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$10.08 |
| Rate for Payer: Aetna Commercial |
$9.07
|
| Rate for Payer: ASR ASR |
$9.78
|
| Rate for Payer: BCBS Trust/PPO |
$7.82
|
| Rate for Payer: BCN Commercial |
$7.82
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cofinity Commercial |
$9.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.06
|
| Rate for Payer: Healthscope Commercial |
$10.08
|
| Rate for Payer: Healthscope Whirlpool |
$9.78
|
| Rate for Payer: Mclaren Commercial |
$9.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.87
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION
|
Facility
IP
|
$293.66
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
8120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$205.56 |
| Max. Negotiated Rate |
$293.66 |
| Rate for Payer: Aetna Commercial |
$264.29
|
| Rate for Payer: Aetna Commercial |
$176.94
|
| Rate for Payer: Aetna Commercial |
$34.85
|
| Rate for Payer: ASR ASR |
$190.70
|
| Rate for Payer: ASR ASR |
$37.56
|
| Rate for Payer: ASR ASR |
$284.85
|
| Rate for Payer: BCBS Trust/PPO |
$152.42
|
| Rate for Payer: BCBS Trust/PPO |
$30.02
|
| Rate for Payer: BCBS Trust/PPO |
$227.67
|
| Rate for Payer: BCN Commercial |
$227.67
|
| Rate for Payer: BCN Commercial |
$152.42
|
| Rate for Payer: BCN Commercial |
$30.02
|
| Rate for Payer: Cash Price |
$157.28
|
| Rate for Payer: Cash Price |
$234.92
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cofinity Commercial |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$36.40
|
| Rate for Payer: Cofinity Commercial |
$276.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.98
|
| Rate for Payer: Healthscope Commercial |
$38.72
|
| Rate for Payer: Healthscope Commercial |
$293.66
|
| Rate for Payer: Healthscope Commercial |
$196.60
|
| Rate for Payer: Healthscope Whirlpool |
$37.56
|
| Rate for Payer: Healthscope Whirlpool |
$284.85
|
| Rate for Payer: Healthscope Whirlpool |
$190.70
|
| Rate for Payer: Mclaren Commercial |
$176.94
|
| Rate for Payer: Mclaren Commercial |
$264.29
|
| Rate for Payer: Mclaren Commercial |
$34.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$167.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.07
|
|
